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[Withdrawn] A guide to immunisation for young people

Updated 7 March 2023

This promotional material was withdrawn on 2 April 2024

This publication was withdrawn on 2 April 2024 as it is now out of date. For the latest information please see Immunisation resources for teenagers and young people.

Applies to England

This guide is for young people in school years 7 to 13, and their parents or guardians. It outlines and explains:

• the immunisations that are given to young people usually when they are still at school
• why these immunisations are needed
• what side effects they might have

The guide also answers some of the most common questions about these immunisations. In particular, it describes the human papillomavirus (HPV) vaccine that protects against HPV related cancers, the tetanus, diphtheria and inactivated poliomyelitis (Td/IPV) vaccine that boosts the protection you got as a child and the meningococcal A, C, W and Y (MenACWY) vaccine.

If you have any questions or want more information, talk to your doctor, school nurse or the practice nurse at your doctor’s surgery.

Pre-school immunisations

By the time you start primary school, you should have had:

Vaccine	How	When	Comments
Flu	Nasal spray	Each year from September	This vaccine is given at 2 and 3 years of age. Children who are in risk groups and cannot have the nasal spray will be offered a vaccination by injection
Diphtheria, tetanus, pertussis (whooping cough) and polio (dTaP/IPV or DTaP/IPV)	One injection	Aged 3 years and 4 months	This is a booster dose of these vaccines
Measles, mumps and rubella (MMR)	One injection	Aged 3 years and 4 months	This is a second dose of the MMR vaccine. (If your child has not had the first dose yet, it should be given now and the second dose 1 month later)

If you have missed these vaccinations, you should catch up before you start secondary school. Please speak to your GP practice to make an appointment.

Importance of immunisation

The national immunisation programme has meant that dangerous diseases, such as polio, have disappeared in the UK. But these diseases could come back – they are still around in many countries throughout the world. That’s why it’s so important for you to protect yourself. In the UK, such diseases are kept at bay by the high immunisation rates.

How vaccines work

A vaccine contains a small part of the bacterium or virus that causes a disease, or tiny amounts of the chemicals the bacterium produces.

Vaccines work by causing the body’s immune system to make antibodies (substances to fight infections and diseases). So if you come into contact with the infection, the antibodies will recognise it and protect you.

Human papillomavirus (HPV)

HPV is very common and it is caught through intimate sexual contact with another person who already has it. Because it is a very common infection, most people will get it during their lifetime.

There are many different types of HPV. Most HPV infections do not cause any symptoms and get better on their own. Some do not clear up and can lead to cancer, whilst others cause genital warts.

HPV related cancers

HPV increases the risk of developing some cancers in later life including cervical cancer (cancer of the entrance to the womb), some mouth and throat cancers and some cancers of the anus and genital area.

HPV causes more than 99% of all cervical cancer, the most common cancer among women aged under 35 years. Most vaginal, vulval, penile and anal cancers are also caused by HPV.

Impact of the HPV vaccine

The HPV vaccine protects against 2 high risk HPV types that cause cancer, including most cases (over 70%) of cervical cancer. Having this vaccine will also protect you against the 2 types of HPV that cause the majority of cases of genital warts. It won’t protect you against any other sexually transmitted diseases such as chlamydia and it won’t stop you getting pregnant.

There is evidence from Australia, Denmark, Scotland and England that the vaccine is already having a major impact on HPV infections.

HPV vaccine has been used in young women in the UK since 2008 and most women aged 15 to 24 years have now been given the vaccine. From September 2019, the vaccine has been offered to young people aged 12 and 13 years.

Over 80 million people have received the vaccine worldwide.

In time, it is expected that the vaccine will save hundreds of lives every year in the UK. A recent Scottish study has already shown a 71% reduction in pre-cancerous cervical disease in young women.

Ten years since the start of the vaccination programme in the UK, there has been a big decline in HPV infections and in the number of young people with genital warts.

HPV infection is very common. More than 70% of unvaccinated people will get it. Having the vaccination will reduce your chance of getting cancers caused by the HPV virus.

Having the HPV vaccination

It is important that you have 2 doses of the HPV vaccine to be protected. The nurse will give you the vaccination in your upper arm. When you are in year 8 you will be offered the first injection. You will be offered the second injection 6 to 12 months after the first, but it can be given up to 24 months after. Your school or GP will inform you when you are due the second dose.

The HPV vaccine is offered to all young people starting in school year 8 (aged 12 to 13 years) and those offered the vaccine at school will remain eligible up to their 25th birthday.

Consent to the HPV vaccine

You will probably want to share information about the vaccine with your parents and discuss it together. If you are being offered the vaccination at school, you may be given a consent form that your parent or guardian should sign giving permission for you to have the vaccination.

The doctor or nurse will discuss the HPV vaccine with you at your appointment and will be able to answer any questions you may have.

HPV vaccine side effects

Like most injections, the side effects of the HPV vaccination are quite mild. Stinging and soreness in the arm are common but wear off in a couple of days. More serious side effects are extremely rare.

The vaccine meets the rigorous safety standards required for it to be used in the UK and has an excellent safety profile. Millions of doses of vaccine have already been given to young women in the UK and around the world. As with all vaccines, any reports of side effects are closely monitored and reviewed.

Find out more information about vaccinations and side effects on NHS.UK.

HPV vaccine and cancer screenings

Women who have had the vaccine will still need to go for cervical screening.

All women aged 25 years and over in England are offered cervical screening tests. The vaccines will prevent up to 90% of cervical cancer cases, but women should still attend for cervical screening when invited to do so.

There are currently no screening programmes for other HPV-related cancers. If you are worried about any symptoms, speak to your GP practice.

Missed vaccination

If you missed either of your vaccinations, for whatever reason, you should speak to your school nurse or GP surgery about making another appointment. It’s best to make your appointment as soon as possible after your original one. The most important thing is to have both doses at the right time to get the best protection.

Young people offered the vaccine are only eligible to start the course of HPV vaccine up to their 25th birthday.

It is best to have your vaccinations at the right time so you are protected. If you miss any of your teenage jabs and you have left school, contact your GP practice and get up to date.

Smear tests after injections

You still need to go for smear tests after you’ve had the injections.

All women are offered cervical screening (smear tests) when they are old enough (aged 25 years and over in England). The vaccine protects against the 2 HPV types that cause 70% of the cases of cervical cancer, so screening is still needed to try to pick up cervical abnormalities caused by other HPV types that could lead to cancer.

Being sexually active and having the vaccination

If you’ve already had sex, and are in the relevant age group, it is important you should still have the vaccine.

No first HPV vaccine before aged 15 years

If you have not had any HPV vaccine by the time you are aged 15 years, you will need need 2 doses of HPV vaccine at least 6 months apart to have full protection.

You should speak to your nurse or doctor about making an appointment as soon as possible.

Contents of the HPV vaccine

A complete list of ingredients for the Gardasil 9 vaccine is available in the Patient Information Leaflets (PIL)s

Further information is available in the Summary of Product Characteristics (SPC).

Tetanus, diphtheria, polio (Td/IPV) and MenACWY

Tetanus

Tetanus is a painful disease affecting the nervous system that can lead to muscle spasms, cause breathing problems and can kill. It is caused when germs found in the soil and manure get into the body through open cuts or burns. Tetanus cannot be passed from person to person.

Diphtheria

Diphtheria is a serious disease that usually begins with a sore throat and can quickly cause breathing problems. It can damage the heart and nervous system, and in severe cases, it can kill.

Polio

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

The teenage booster vaccine is called Revaxis, you can read the Patient Information Leaflet for further information.

Meningococcal disease

Meningitis and septicaemia

Meningitis is dangerous swelling of the lining around the brain and spinal cord. It can be the result of infection with bacteria or a virus or as a result of injury.

Septicaemia is when bacteria enter the bloodstream and cause blood poisoning which can trigger sepsis. Sepsis is an overwhelming and life-threatening immune response to any infection and can lead to tissue damage, organ failure and death.

Meningococcal disease can cause both meningitis and septicaemia. There are 5 main groups of meningococcal bacteria that cause disease:

• meningococcal group A (MenA)
• meningococcal group B (MenB)
• meningococcal group C (MenC)
• meningococcal group W (MenW)
• meningococcal group Y (MenY)

Meningococcal disease is rare but very serious and requires urgent hospital treatment. It can lead to life-changing disabilities such as amputations, hearing loss, brain damage and scars.

There is more information in the Knowing about meningitis and septicaemia section.

Immunisations as a child

If you were immunised against tetanus, diphtheria and polio as a child, you are not fully protected and will still need a booster.

If you were immunised against MenC as a child, the MenACWY vaccine will increase your protection against MenC disease and help to protect you against the 3 other meningococcal groups (A, W and Y).

Boosters you need to have

You need a total of 5 doses of tetanus, diphtheria and polio vaccines to build up and keep your immunity. You should have had:

• the first 3 doses as a baby
• the fourth dose when you were aged between 3 and 5 years, before you started school
• the fifth dose is due in year 9 (aged 13 to 14 years).

For protection against 4 groups (A, C, W and Y) of meningococcal infection, it is important to have one dose of MenACWY as a teenager:

• the routine dose of MenACWY is given in year 9 or 10 (aged around 14 years)

If you missed your teenage dose of MenACWY vaccine

If you were born on or after 1 September 1996 and are eligible but missed your teenage MenACWY vaccine, you can still have the vaccine up to your 25th birthday. If you are older and starting university for the first time, you can still have the vaccine up to your 25th birthday.

If you are still at school then speak to your school provider, otherwise you will need to make an appointment with your GP practice.

MenACWY vaccine protection against Men B

MenB is caused by different group of the bug which commonly affects young infants. A different vaccine, which protects against MenB, is given to very young babies. Some adults and older children considered at risk may be eligible on the NHS. You can find out more about how to get the MenB vaccine through the charity websites.

If you have any questions about MenACWY, talk to your school nurse or doctor.

Boosters in the future

You will probably not need further boosters of these vaccines. However, you may need extra doses of some vaccines if you are visiting certain countries or if you have an injury, you may need another tetanus injection.

Check with your practice nurse at your surgery.

How you will be given the Td/IPV and MenACWY boosters

You will have 2 injections – one in each upper arm, or 2.5cm apart in the same arm.

Nobody likes injections, but it is very quick. The needles used are small and you should feel only a tiny pinprick. If you are a bit nervous about having the injection, tell the nurse or doctor before you have it.

Other immunisations

When you are having your Td/IPV, and MenACWY vaccines, it’s a good idea to check with the nurse or doctor that all your other immunisations are up to date including the measles, mumps and rubella (MMR) vaccine.

It’s particularly important to check that your MMR immunisation is up to date because some teenagers have not had 2 doses of MMR. If you have never had the MMR vaccine, you should have one dose now and another one month later.

Potential reasons why you should not be immunised

There are very few teenagers who may not have the HPV, Td/IPV, and MenACWY vaccines.

You should talk to your doctor or school nurse if you are ‘immunosuppressed’ because you are having treatment for a serious condition such as a transplant or cancer, or you have a condition that affects your immune system, such as severe primary immunodeficiency. The doctor or nurse will get specialist advice on whether you should have the MMR vaccine.

In the UK we have 2 MMR vaccines. Both vaccines work very well, one contains porcine gelatine and the other doesn’t. If you want to have the porcine gelatine free vaccine, talk to your nurse or GP.

Illness on the day of the appointment

If you have a minor illness without a fever, such as a cold, you should still have the immunisations.

If you are ill with a fever, put the immunisations off until you have recovered. This is to avoid the fever being associated with the vaccines and the vaccines increasing the fever you already have.

You should speak to your doctor or nurse before having the immunisation if you have:

• had a bleeding disorder or
• had convulsions (fits) not associated with fever

Side effects

It is common to get some swelling, redness or tenderness where you have the injection. Sometimes a small painless lump develops, but this usually disappears in a few weeks. More serious effects are rare but include fever, headache, dizziness, feeling sick and swollen glands.

You may experience side effects from the MMR vaccine for up to 6 weeks after the immunisation. The symptoms are similar to those caused by the diseases, but much milder. Speak to your school nurse or doctor if you are at all concerned.

If you feel unwell after the immunisation, take paracetamol or ibuprofen. Read the instructions on the bottle or packet carefully and take the correct dose for your age. If necessary, take a second dose 4 to 6 hours later. If your temperature is still high after the second dose, speak to your GP or call the free NHS helpline 111.

Never give medicines that contain aspirin to young people aged under 16 years.

It is not generally recommended that these medicines are routinely given before or after vaccination in anticipation of a fever. There are 2 MenACWY vaccines, they are called MenVeo and Nimenrix, you can read the Patient Information leaflets here:

• Nimenrix
• MenVeo

Knowing about meningitis and septicaemia

Meningitis is an infection of the brain. The same germ that causes meningitis can cause septicaemia (blood poisoning). Meningitis and septicaemia are both very serious – they can cause permanent disability and death and the signs can come on quickly – so you must get treatment straight away.

MenACWY vaccine does not protect against all the other bacteria and viruses that cause meningitis and septicaemia, so you still need to know the signs and symptoms.

Signs and symptoms

Many of the early signs – diarrhoea, vomiting, fever, aches, general tiredness and headaches – are also signs of less serious illnesses like colds and flu.

Someone with meningitis and septicaemia will usually become seriously ill in a matters of hours. This is why it is important to keep checking on someone who is ill so you spot if they are getting rapidly worse. It’s also important to look for cold hands and feet.

Symptoms such as a rash that doesn’t fade (do the glass test), being confused or delirious, or too sleepy to wake occur later and are very serious – seek help immediately.

For meningitis, the most important signs to look out for are:

• fever
• a very bad headache (this alone is not a reason to get medical help)
• vomiting
• stiff neck
• dislike of bright lights
• rash
• confusion, delirium
• severe sleepiness, losing consciousness
• seizures

For septicaemia, the most important signs to look out for are:

• fever and shivering
• severe pains and aches in limbs and joints
• vomiting
• very cold hands and feet
• pale or mottled skin
• rapid breathing
• diarrhoea and stomach cramps
• red or purple ‘bruised’ or blotchy rash on skin that do not fade under pressure – do the glass test. On dark skin, check inside the eyelids or roof of the mouth where the spots may be more visible
• difficulty walking or standing
• severe sleepiness, losing consciousness

What you should do

Not all of these symptoms will develop and they can appear in any order and be mixed between the 2 illnesses. Meningococcal disease can be hard to identify at first because it can be like a bad case of flu.

However, anyone affected with meningococcal disease will usually become seriously ill within a few hours. You should contact your GP (family doctor) or NHS 111 for advice if you have any concerns about your own or a friend’s health.

If you become worried about yourself or a friend, particularly if symptoms are getting worse, seek medical help urgently at the closest Accident and Emergency (A&E) Department or by dialling 999. Early treatment can be life-saving.

The ‘glass test’

Press the side of a clear drinking glass firmly against the rash so you can see if the rash fades and loses colour under pressure. If it doesn’t change colour, contact your doctor immediately.

On dark skin, check inside the eyelids or roof of the mouth where the spots maybe more visible.

Immunisation schedules

1. The routine immunisation schedule.
2. Selective immunisation programmes.
3. Additional vaccines for individuals with underlying medical conditions.

Vaccine Damage Payment Scheme

Current immunisations are extremely safe but, very rarely, an individual may suffer from a problem after vaccination.

The Vaccine Damage Payment Scheme is designed to ease the present and future burdens of the person who, on that very rare occasion, may be affected by the vaccination.

There are several conditions that need to be met before a payment can be made. For more information, visit Vaccine Damage Payment on GOV.UK.

Vaccine Damage Payments Unit
Department for Work and Pensions
Palatine House, Lancaster Road
Preston
PR1 1HB

You can contact them by phone on 01772 899944, or by email at cau-vdpu@dwp.gsi.gov.uk

If you want advice on immunisation, speak to your doctor, practice nurse, health visitor or pharmacist, or call the NHS helpline 111.

Find more information on vaccinations on NHS.UK.

Further information

For non-urgent advice, call the free NHS helpline 111.

From NHS.UK, you will find information on:

• teenage vaccinations
• cervical cancer
• cervical screening
• measles, mumps and rubella and the MMR vaccine

An informative leaflet for young people on measles, mumps and rubella and the MMR vaccine is available to order for free, or download from GOV.UK.

For meningitis, the following charities provide information, advice and support:

• Meningitis Research Foundation, free helpline 080 8800 3344 - Monday to Friday, 9am to 5pm
• Meningitis Now, free helpline 0808 80 10 388 - Monday to Thursday 9am to 4pm and Fridays 9am to 1pm

If you have any questions or want more information, talk to your doctor, school nurse or the practice nurse at your doctor’s surgery.

Order or download print copies

Paper copies of the leaflet are available to order for free, or download a copy to print.