a guide to vaccinations for 3- to 5-year-olds · what is tetanus? tetanus is a disease affecting...

Pre-school immunisationsA guide to vaccinationsfor 3- to 5-year-olds

Edition2006

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If you want more information on vaccines and immunisations, speak to your doctor, health visitor or nurse. Or visit our websitewww.healthscotland.com/immunisation or call the NHS Helpline,Freephone on 0800 22 44 88.

This leaflet is available in the above languages on our website:www.healthscotland.com/immunisation or on request. An audioversion and further languages are also available on request.

Contents4 Introduction

6 Common questions about pre-school immunisations

13 Immunisations for pre-school children

13 dTaP/IPV or DTaP/IPV vaccine

15 MMR vaccine

22 Watch out for meningitis and septicaemia

25 Travel advice for children

27 Glossary of terms

Back cover Routine childhood immunisationprogramme – a quick reference guideto your child’s immunisations

For more information visit www.immunisation.nhs.uk

IntroductionThis guide is for parents or guardians of children aged threeto five years old. It provides information on the routineimmunisations that are given to children before they startschool to protect them from serious childhood diseases. Itdescribes these diseases and explains why young childrenneed protection against them. It also answers some of themost common questions about pre-school immunisation.

If you have more questions or you want more information,talk to your doctor, practice nurse or health visitor.

You can also visit our website atwww.healthscotland.com/immunisationor call NHS Helpline, Freephone 0800 22 44 88

Introduction

Vaccine How it is given Comments

Diphtheria, tetanus, One injection This is a booster dose of thepertussis (whooping vaccine your child had as a cough) and polio baby, but without the Hib part.(dTaP/IPV or DTaP/IPV)

Measles, mumps One injection This is a second dose of the MMRand rubella (MMR) vaccine. (If your child has not had

the first dose yet, it should be givennow and they should have their second dose in three months’ time.)

Timetable of pre-school immunisationsThese immunisations are due about three years after yourchild has completed the immunisations they had when theywere two, three and four months old. You will receive anappointment for you to bring your child for their pre-schoolimmunisations.

The table below shows the pre-school immunisations yourchild will be offered. These immunisations will make sure thatyour child has the best protection against serious childhooddiseases as they grow up.

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For more information visit www.healthscotland.com/immunisation6

Common questions about pre-school immunisationsWhy does my child need to be immunised at this age?Protection (immunity) against diphtheria, tetanus, whoopingcough and polio can fade over time. Also, immunity tomeasles, mumps and rubella may not develop after a singledose of the MMR vaccine. The pre-school immunisations –often called pre-school boosters – will top up your child’s levelof antibodies (the substances our bodies produce to fight offdisease and infection) and help to keep them protected.

When you take your child for their pre-school immunisations,you will have the chance to make sure their otherimmunisations are up to date.

How do vaccines work?Vaccines contain a small part of the bacterium or virus thatcauses a disease, or tiny amounts of the chemicals thebacterium produces. Vaccines work by causing the body’simmune system to make antibodies. If your child comes intocontact with the infection, the antibodies will recognise it andbe ready to protect him or her. Because vaccines have beenused so successfully in the UK, diseases such as polio havedisappeared from this country.

If your child missed any of their immunisations as ababy or toddler, this is a good time to ask the surgeryor clinic about catch-up doses. It is never too late tohave your child immunised. You don’t have to start thecourse of immunisations from the beginning again butyou can catch up on them and make sure your child isfully protected.

How do we know that vaccines are safe?Before a vaccine is allowed to be used, its safety andeffectiveness have to be thoroughly tested. After they have beenlicensed, the safety of vaccines continues to be monitored. Anyrare side effects that are discovered can then be assessed further.All medicines can cause side effects, but vaccines are amongthe very safest. Research from around the world shows thatimmunisation is the safest way to protect your child’s health.

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Do these vaccines contain thiomersal?No. These pre-school vaccines do not contain thiomersal.Thiomersal is a mercury-based preservative (see the glossary onpage 27).

We don’t hear about most of these diseases any more, soare these immunisations really necessary?Since immunisation was introduced in the UK, the number ofchildren catching these diseases is low. But if children do notcontinue to be immunised, the diseases will come back. Thediseases are still around in Europe and parts of the world and,as people travel more, and more people come to visit thiscountry, there is always a risk that the diseases will bebrought into the country and your child will catch them.

Will there be any side effects from the vaccines?There may be side effects, but they are usually mild. Yourchild may get a little redness, swelling or tenderness wherethe injection was given. This will disappear on its own. Somechildren may get a fever. You can treat the fever by givingyour child paracetamol or ibuprofen liquid. Read theinstructions on the bottle carefully and give your child thecorrect dose for their age. If necessary, give them a seconddose four to six hours later. If your child’s temperature is stillhigh after they have had a second dose, speak to your doctoror call NHS 24 on 0845 24 24 24.

Remember, never give medicines that contain aspirin tochildren under 16.

For more information visit www.healthscotland.com/immunisation

9Common questions about pre-school immunisations

I’m worried that my son may have allergies. Can he havethe vaccine?Yes. Asthma, eczema, hay fever, food intolerances and allergiesdo not prevent your child having any vaccine in the routinechildhood immunisation programme. If you have any questions,speak to your doctor, practice nurse or health visitor.

Are some children allergic to vaccines?Very rarely, children can have an allergic reaction soon afterimmunisation. This may be a rash or itching affecting partor all of the body. The doctor or nurse giving the vaccinewill know how to treat this. It is not a reason to withholdfurther immunisations.

Even more rarely, children can have a severe reaction, withina few minutes of the immunisation, which causes breathingdifficulties and can cause the child to collapse. This is calledan anaphylactic reaction. A recent study has shown that onlyone anaphylactic reaction occurs in about a millionimmunisations. The people who give immunisations aretrained to deal with anaphylactic reactions and childrenrecover completely with treatment.

An anaphylactic reaction is a severe and immediateallergic reaction that needs urgent medical attention.


Are there any reasons why my child should not be immunised?There are very few children who cannot be immunised. Thevaccines should not be given to children who have had:

n a confirmed anaphylactic reaction to a previous dose ofthe vaccine, or

n a confirmed anaphylactic reaction to neomycin, streptomycin,or polymyxin B (antibiotics that may be added to vaccines invery tiny amounts).

There are no other medical reasons why these vaccines shouldnot be given. If you are worried, talk to your health visitor,practice nurse or doctor.

What about the MMR vaccine? Are there any otherreasons why my child should not receive this vaccine?

MMR is a live attenuated vaccine (that is, it contains live virusesthat have been weakened). Children who are‘immunosuppressed’ should not, in general, receive live vaccines.

Children who are immunosuppressed include those:

n whose immune system is suppressed because they areundergoing treatment for a serious condition such as atransplant or cancer, or

n who have any condition which affects the immune system,such as severe primary immunodeficiency.

If this applies to your child, you must tell your doctor, practicenurse or health visitor before the immunisation. They will getspecialist advice.

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What if my child is ill on the day of the appointment?If your child has a minor illness without a fever, such as acold, they should have their immunisations as normal.

If your child is ill with a fever, put off the immunisation untilthe child has recovered. This is to avoid the fever beingassociated with the vaccine, or the vaccine increasing thefever your child already has.

If your child:

n has a bleeding disorder, orn has had a fit not associated with fever

they can receive immunisations, but may need additional careso speak to your doctor, practice nurse or health visitor beforeyour child has any immunisation.

What are fits?Fits are also called seizures or convulsions. Some are associatedwith fever and some are not.

In the first five years of a child’s life, the commonest type offit is caused by fever (this may be called a febrile seizure orfebrile convulsion). Sometimes immunisation is followed by afever that may cause a febrile seizure. Most children whohave febrile seizures recover fully.

When a seizure occurs within a short time after immunisation,it might not have been caused by the vaccine or the fever. Itcould be due to an underlying medical condition.

If your child has a fit after an immunisation, contact yourdoctor who may refer you to a specialist for advice aboutfurther investigations and future immunisations.

If the surgery is closed or if you can’t contact your doctor, gostraight to the emergency department of your nearest hospital.

12 For more information visit www.healthscotland.com/immunisation

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Immunisations for pre-school children

dTaP/IPV or DTaP/IPV vaccineBooster given at 3 years 4 months to 5 years of ageThis vaccine boosts the immunisations that were given to yourchild at two, three and four months of age. It protects againstdiphtheria, tetanus, pertussis (whooping cough) and polio.

What is diphtheria?Diphtheria is a serious disease that usually begins with a sorethroat and can quickly develop to cause breathing problems.It can damage the heart and nervous system and, in severecases, it can kill.

What is tetanus?Tetanus is a disease affecting the nervous system which canlead to muscle spasms, cause breathing problems and can kill.It is caused when germs that are found in soil and manure getinto the body through open cuts or burns. Tetanus cannot bepassed from person to person.

What is pertussis (whooping cough)?Whooping cough is a disease that can cause long bouts ofcoughing and choking making it hard to breathe. Whoopingcough can last for up to ten weeks. It is not usually so seriousin older children, but it can be very serious and it can killbabies under one year old.


What is polio?Polio is a virus that attacks the nervous system which cancause permanent paralysis of the muscles. If it affects thechest muscles or the brain, polio can kill.

How effective are these pre-school vaccines?Studies have shown that the vaccines are very effective. Thebooster will not only protect your child, it will also prevent theinfections from being passed on to babies who are too youngto have had all of their immunisations.

Are there any side effects from these vaccines?Your child may have some redness, swelling or tendernesswhere they had the injection, but this will usually disappear ina few days. A hard lump may appear in the same place butthis will also go, usually over a few weeks. Occasionally,children may be unwell and irritable and develop atemperature, headache, sickness and swollen glands.

What is the difference between dTaP/IPV and DTaP/IPV,and does the difference matter?Diphtheria vaccines are produced in two strengths, dependingon how much diphtheria toxoid (the toxin produced bydiphtheria bacteria that has been inactivated) they contain.The two strengths are abbreviated to ‘D’ for the high strengthand ‘d’ for the low strength. There are two vaccines availablefor use in the pre-school booster – one containing the high-strength diphtheria (DTaP/IPV) and the other containinglow-strength diphtheria (dTaP/IPV). Both vaccines have beenshown to provide good responses, so it doesn’t matter whichone your child has for their pre-school booster.


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MMR vaccineSecond dose given pre-schoolThe MMR vaccine protects against measles, mumps and rubella.

What is measles?Measles is caused by a very infectious virus. Nearly everyonewho catches it will have a high fever, a rash and generally beunwell. Children often have to spend about five days in bedand may be off school for ten days. Adults are likely to be illfor longer. It is not possible to tell who will be seriouslyaffected by measles. The complications of measles affect onein every 15 children. The complications include chestinfections, fits, encephalitis (infection of the brain), and braindamage. In very serious cases, measles kills.

How is it spread?Measles is one of the most infectious diseases known. A coughor a sneeze can spread the measles virus over a wide area.Because it’s so infectious, the chances are your child will getmeasles if he or she is not protected.

What is mumps?Mumps is caused by a virus which can lead to fever,headache, and painful, swollen glands in the face, neck andjaw. It can result in permanent deafness, viral meningitis(infection of the lining of the brain) and encephalitis. Rarely, itcauses painful swelling of the testicles in males and theovaries in females. Mumps lasts about seven to ten days.

How is it spread?Mumps is spread in the same way as measles. It is about asinfectious as flu.

What is rubella?Rubella (German measles) is a disease caused by a virus. Inchildren it is usually mild and can go unnoticed. It causes ashort-lived rash, swollen glands and a sore throat. Rubella is veryserious for unborn babies. It can seriously damage their sight,hearing, heart and brain. This condition is called congenitalrubella syndrome (CRS). Rubella infection in the first threemonths of pregnancy causes damage to the unborn baby in upto nine out of ten cases. In many of the cases, pregnant womencaught rubella from their own, or their friends’, children.

How is it spread?Rubella is spread in the same way as measles and mumps. It isabout as infectious as flu.


Immunisations for pre-school children 17

How effective is the MMR vaccine?In 1988, before the MMR vaccine was introduced, around86,000 cases of measles were reported in the UK, mostly inchildren. Sixteen of these cases resulted in death. In 2003,there were around 350 confirmed cases of measles. Since1992, there has been one death in the UK from acute measles.

Before the MMR vaccine was introduced, mumps was themost common cause of viral meningitis in children under 15.It led to 1,200 people across the UK going into hospital eachyear. If children aren’t immunised with the MMR vaccine, theyare at risk of getting mumps.

In each of the five years before the MMR vaccine wasintroduced, there were around 43 cases of congenitalrubella syndrome in the UK. In recent years, there has beenan average of fewer than two cases every year. All but oneof these cases was caught abroad. The one case caught inthe UK was linked to an outbreak of rubella that began inthis country after someone caught the disease abroad. It isimportant that all children (boys and girls) are protectedagainst rubella to prevent the number of cases increasing.

Although all three diseases are uncommon in the UK, childrenwho are not immunised are still at risk of catching them. Inorder for everybody to be protected, over 95% of childrenneed to be immunised with MMR so the diseases cannotcirculate. However, immunisation levels are currently belowthis and outbreaks of measles and mumps have occurred inchildren who have not been properly protected.


Immunising your child with two doses of the MMR vaccinewill give them the best protection. In Finland, whereimmunisation rates of MMR have remained high, two dosesof MMR have been routinely given since 1982. This has led tomeasles, mumps and rubella being wiped out in Finland.

Why does my child need two doses of MMR vaccine?Your child needs a second dose of MMR because it doesn’talways work fully the first time. Some children who have onlyone dose of the vaccine might not be protected against oneor more of the diseases.

If your child has not had an MMR vaccination before,they should have the first dose now and the second doseafter three months. Ask your health visitor or doctorfor more information – it’s never to late to catch up.

Two doses of the MMR vaccine are routinely given acrossEurope as well as in the US, Canada, Australia and NewZealand. By giving your child a second dose of the MMRvaccine, you can make sure they have the best possibleprotection for the future.

Are there any side effects from the second (pre-school)dose of the MMR vaccine?It is even less common to have side effects after the seconddose than after the first dose. When side effects do happen,they are usually milder.

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The three different viruses in the vaccine act at different timesand can produce the following side effects.

n Six to ten days after the immunisation, some children may become feverish, develop a measles-like rash and go off their food as the measles part of the vaccine starts to work.

n Rarely, children may get mumps-like symptoms (fever andswollen glands) about three weeks after their immunisationas the mumps part of the vaccine starts to work.

n Very rarely, children may get a rash of small bruise-likespots in the six weeks after the vaccination. This is usuallycaused by the measles or rubella parts of the vaccine. Ifyou see spots like these, take your child to the doctor tobe checked. He or she will tell you how to deal with theproblem and how to protect your child in the future.

If your child gets any of these reactions, he or she will not beinfectious and can mix with other people as normal.

n Very rarely, a child may have a fit caused by a fever. This iscalled a ‘febrile convulsion’ (see page 12). However, if achild has not been immunised and gets measles, they arefive times more likely to have a fit.

n Fewer than one child in a million develops encephalitis(swelling of the brain) after the MMR vaccine, and there isvery little evidence that it is actually caused by the vaccine.However, if a child catches measles, the chance ofdeveloping encephalitis is between one in 200 and one in5000. Around a third of these children will be left withpermanent brain damage.


MMR is a live vaccine. Does this mean my child can passthe infection to other people?No, your child will not be infectious.

Egg allergiesThe MMR vaccine can safely be given to children who have hada severe allergy (anaphylactic reaction) to egg. If you have anyconcerns, talk to your health visitor, practice nurse or doctor.

A few years ago, some people said that the MMR vaccinecould cause autism and bowel disease. How do I knowthat MMR is truly safe?There have been many stories in the media suggesting a linkbetween the MMR vaccine and autism and bowel disease.Independent experts from around the world looked verycarefully at this possibility and there is no credible scientificevidence of a link between MMR and autism or bowel disease– and there is a lot of research that shows there is no link.The MMR vaccine has been used in over 100 countries and it has an excellent safety record. If you want moreinformation, ask your health visitor, practice nurse or doctorfor a copy of the MMR leaflet or look on the websitewww.healthscotland.com/immunisation. Or call the NHS Helpline, Freephone 0800 22 44 88.


Wouldn’t it be better for my child to have MMR inseparate vaccines?No. The World Health Organization advises against givingseparate vaccines. No country in the world recommendssingle vaccines when MMR is available. Giving the vaccinesseparately leaves children at risk of catching measles,mumps or rubella between the three injections. There is no evidence that single immunisations are safer than theMMR vaccine.

Pre-school immunisations give your child the bestprotection before they start school. If your child hasmissed any immunisations, they can have them now.Talk to your doctor, practice nurse or health visitor.

Remember, these will be the last routine immunisations yourchild will receive before the final set of boosterimmunisations given to them as teenagers.

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Watch out for meningitis and septicaemiaWhat are meningitis and septicaemia?Meningitis is infection of the lining of the brain. The samegerms that cause meningitis may cause septicaemia (bloodpoisoning). Both meningitis and septicaemia are very seriousin young children and the signs can come on quickly. If yoususpect meningitis or septicaemia get help urgently.

Although your child was immunised as a baby against Hiband meningococcal C (MenC), both of which cause meningitisand septicaemia, these vaccines will not protect them againstother types of meningitis and septicaemia. So it’s important toknow the signs and symptoms.

What are the signs and symptoms of meningitis andsepticaemia?Early symptoms of meningitis and septicaemia are mild andthey are similar to the symptoms of flu (for example, a fever,vomiting, being irritable and pain in the back or joints). But themost important signs of meningitis to look out for in children are:

n a stiff neck (check that your child can kiss their knee, ortouch their forehead with their knees)

n a very bad headache (this alone is not a reason to get medical help)

n a dislike of bright lights

n vomiting

n a fever

n drowsy, less responsive and confused, and

n a rash.


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The main signs of septicaemia are:

n sleepiness, less responsive, vacant or confused (a late sign)

n severe pains and aches in the arms, legs and joints

n very cold hands and feet

n shivering

n rapid breathing

n red or purple spots that don’t fade when you press them(do the glass test explained below)

n vomiting

n a fever, and

n diarrhoea and stomach cramps.

What should I do?If your child develops one or more of the symptoms describedabove, get medical help urgently. If you can’t get in touch withyour doctor, or are still worried after getting advice, trust yourinstincts and take your child to the emergency department ofyour nearest hospital.

The ‘glass’ testPress the side of a drinking glass firmly againstthe rash so you can see if the rash fades andloses colour under pressure. If it doesn’t changecolour, contact your doctor immediately.

Watch out for meningitis and septicaemia


Where can I get more information?The Meningitis Research Foundation, the MeningitisAssociation of Scotland and the Meningitis Trust all provideinformation on meningitis.

Phone the Meningitis Research Foundation’s free 24-hourhelpline on 080 8800 3344 or visit the website atwww.meningitis.org.

Phone or fax the Meningitis Association of Scotland on 0141 427 6698, or write to them at 9 Edwin Street, GlasgowG51 1ND, or visit the website at www.meningitis-scotland.org.

Phone the Meningitis Trust’s 24-hour helpline on 0845 6000 800or visit the website at www.meningitis-trust.org.

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Travel advice for childrenIf your child is going abroad, make sure their routineimmunisations are up to date. Your child may also needextra immunisations.

Contact your doctor’s surgery or a travel clinic well in advance(at least 6 weeks) for up-to-date information on theimmunisations your child may need. Information can also befound on the NHS Scotland website www.fitfortravel.nhs.uk.Courses of most travel vaccines can be given over a four-weekperiod, but more time will be needed if a course of theDTaP/IPV/Hib vaccine has to be given. If you find that you haveless time before departure, it is still worth attending a clinic tomake sure you can get as much protection as possible as well asinformation about reducing the risks of ill health abroad.

Your child may need to be immunised against other diseasessuch as yellow fever, and have a vaccination certificate asproof, before they can enter some countries. The yellow fevervaccination certificate becomes valid and effective ten daysafter the vaccination is given.

Watch out for malariaMalaria is a serious infection that you can catch from mosquitobites. It is a major problem in tropical countries. If you are travellingto an area where there is malaria, your child will need protection.

There isn’t an immunisation against malaria, but your doctorwill be able to give you advice on taking anti-malarial drugs.

Travel advice for children

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Anti-malarial drugs do not provide complete protection but areimportant when travelling to some parts of the world. They can be quite difficult to take but some are now made especiallyfor children.

Avoiding mosquito bitesDo all you can to prevent your child from getting bitten by mosquitoes.

n During the day and night, use clothes that cover the armsand legs.

n Use insect repellent on the skin and a mosquito net soakedin insecticide.

Use an insect repellent suitable for children. Ask your pharmacistfor advice.

For more informationYou can get Health advice for travellers, an information leafletproduced by the Department of Health, from the post office or bycontacting the DH Publications order line on 08701 555 455, anytime, quoting T7 Health advice for travellers.

You can also get further information on the NHS Scotlandwebsite www.fitfortravel.nhs.uk and the Department of Healthwebsite at www.dh.gov.uk.


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Glossary of termsThis glossary describes some of the terms relevant to yourchild’s immunisations.

Acellular pertussis vaccineWhooping cough vaccine containing only parts of the pertussisbacterial cells which can produce immunity in the personreceiving the vaccine.

Anaphylactic reactionAn immediate and severe allergic reaction which needs urgentmedical attention.

ContraindicationFactors that indicate that a certain procedure or treatmentshould not be carried out.

dTaP/IPV and DTaP/IPVCombined vaccines that protect against four different diseases– diphtheria, tetanus, pertussis (whooping cough) and polio.They contain acellular pertussis vaccine and inactivated poliovaccine. They are given to three- to five-year-olds as apre-school immunisation.

DTaP/IPV/Hib vaccineA combined vaccine that protects against five differentdiseases – diphtheria, tetanus, pertussis (whooping cough),polio and Haemophilus influenzae type b (Hib). It containsacellular pertussis vaccine and inactivated polio vaccine. It isgiven to babies at two, three and four months of age.

Glossary of terms

Inactivated polio vaccine (IPV)Polio vaccine made from viruses that have been killed.

NeomycinAn antibiotic put into vaccines to prevent contamination bybacteria.

Polymyxin BAn antibiotic put into vaccines to prevent contamination bybacteria.

StreptomycinAn antibiotic put into vaccines to prevent contamination bybacteria.

Td/IPVA combined vaccine that protects against three differentdiseases – tetanus, diphtheria, and polio. It contains tetanus,low-dose diphtheria and inactivated polio vaccine. It is givento young people aged 13 to 18 years to give longer-termprotection against the three diseases.

ThiomersalThiomersal is a mercury-based preservative that has been usedin vaccines for more than 60 years. Thiomersal is not used inthe vaccines used in the UK routine vaccination programme. Formore information on thiomersal, see the immunisationfactsheet on www.immunisation.nhs.uk.

ToxoidAn inactivated bacterial toxin that stimulates an immuneresponse when used in a vaccine.


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Vaccine Damage Payment SchemeMost immunisations are given without any trouble at all, butvery rarely there may be problems. The Vaccine DamagePayment Scheme is designed to ease the present and futureburdens of the person affected by the vaccinations, and theirfamily. It covers all the vaccines described in this leaflet excepthepatitis B vaccine. There are several conditions that need tobe met before a payment can be made. If you need moreinformation, please contact:

Vaccine Damage Payments UnitDepartment for Work and PensionsPalatine HouseLancaster RoadPrestonPR1 1HB.Phone: 01772 899944E-mail: [email protected]

Further adviceIf you want advice on immunisation, speak to your doctor,practice nurse or health visitor, or call NHS Helpline,Freephone 0800 22 44 88.

For more information or to ask questions, visitwww.healthscotland.com/immunisation.

Glossary of terms

For more information visit www.healthscotland.com/immunisationFor more information visit www.healthscotland.com/immunisation30

‘The two public healthinterventions that have had the greatest impact on theworld’s health are clean water and vaccines.’

World Health Organization

Published on behalf of the Scottish Executive by NHS Health Scotland.

Adapted, with permission, from material originally published by the Department of Health Publications.

© NHS Health Scotland 2006

ISBN: 1-84485-357-8

Health Scotland

Edinburgh office:Woodburn HouseCanaan LaneEdinburgh, EH10 4SG

Glasgow office:Clifton HouseClifton PlaceGlasgow, G3 7LS

When to immunise Diseases protected against Vaccine given

Two months old Diphtheria, tetanus, pertussis DTaP/IPV/Hib and(whooping cough), polio and Pneumococcal Haemophilus influenzae type b (Hib) conjugate vaccinePneumococcal infection (PCV)

Three months old Diphtheria, tetanus, pertussis, polio and DTaP/IPV/Hib andHaemophilus influenzae type b (Hib) MenCmeningococcal C (MenC)

Four months old Diphtheria, tetanus, pertussis, polio and DTaP/IPV/Hib, Haemophilus influenzae type b (Hib) MenC and PCVmeningococcal C (MenC)Pneumococcal infection

Around 12 months Haemophilus influenza type b (Hib) and Hib/MenCmeningococcal C (MenC)

Around 13 months Measles, mumps and rubella (German MMR and PCVmeasles)Pneumococcal infection

Three years four Diphtheria, tetanus, pertussis and polio DTaP/IPV or dTaP/IPV months to five Measles, mumps and rubella and MMRyears old

Thirteen to eighteen Tetanus, diphtheria and polio Td/IPVyears old

Routine childhood immunisation programmeEach vaccination is given as a single injection into the muscle ofthe thigh or upper arm

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