Guidance

Vaccination of individuals with uncertain or incomplete immunisation status: from 1 September 2023

Updated 6 September 2023

Applies to England

General principles

Unless there is a documented or reliable verbal vaccine history, individuals should be assumed to be unimmunised and a full course of immunisations planned.

Individuals coming to the UK part way through their immunisation schedule should be transferred onto the UK schedule and immunised as appropriate for age.

If the primary course has been started but not completed, resume the course – no need to repeat doses or restart course.

Plan catch-up immunisation schedule with minimum number of visits and within a minimum possible timescale – aim to protect the individual in the shortest time possible.

Infants from 2 months of age up to first birthday

DTaP/IPV/Hib/HepB ^{[footnote 1]}, ^{[footnote 2]} and MenB ^{[footnote 3]} and rotavirus ^{[footnote 4]}

Four week gap

DTaP/IPV/Hib/HepB and PCV13 ^{[footnote 5]} and rotavirus ^{[footnote 4]}

Four week gap

DTaP/IPV/Hib/HepB and MenB ^{[footnote 3]}

Boosters and subsequent vaccination

As per UK schedule ensuring at least a 4 week interval between primary DTaP/IPV/Hib/HepB and the booster Hib/MenC dose, and a minimum 4 week interval between MenB and PCV13 priming and booster doses.

Children from first up to second birthday

DTaP/IPV/Hib/HepB ^{[footnote 1]}, ^{[footnote 6]} and PCV13 ^{[footnote 7]} and Hib/MenC ^{[footnote 7]} and MenB ^{[footnote 8]}) and MMR

Four week gap

DTaP/IPV/Hib/HepB ^{[footnote 6]}

Four week gap

DTaP/IPV/Hib/HepB ^{[footnote 6]} and MenB ^{[footnote 8]}

Boosters and subsequent vaccination

As per UK schedule.

See MMR – from first birthday onwards.

See Flu vaccine.

Children from second up to tenth birthday

DTaP/IPV/Hib/HepB ^{[footnote 1]}, ^{[footnote 6]} and Hib/MenC ^{[footnote 9]} and MMR

Four week gap

DTaP/IPV/Hib/HepB ^{[footnote 6]} and MMR

Four week gap

DTaP/IPV/Hib/HepB ^{[footnote 6]}

Boosters and subsequent vaccination

First booster of dTaP/IPV can be given as early as one year following completion of primary course to re-establish on routine schedule.

Additional doses of DTaP-containing vaccines given under 3 years of age in some other countries do not count as a booster to the primary course in the UK and should be discounted.

Subsequent vaccination – as per UK schedule.

See MMR – from first birthday onwards.

See Flu vaccine.

From tenth birthday onwards

Td/IPV ^{[footnote 1]} and MenACWY ^{[footnote 10]} and MMR

Four week gap

Td/IPV and MMR

Four week gap

Td/IPV

Boosters and subsequent vaccination

First booster of Td/IPV – preferably 5 years following completion of primary course. Second booster of Td/IPV – ideally 10 years (minimum 5 years) following first booster.

Subsequent vaccination – as per UK schedule.

See MMR – from first birthday onwards.

See Flu vaccine.

See HPV vaccine.

See Shingles vaccine.

See Pneumococcal polysaccharide vaccine (PPV).

Measles, mumps and rubella vaccine (MMR) – from first birthday onwards

• doses of measles-containing vaccine given prior to 12 months of age should not be counted
• 2 doses of MMR should be given irrespective of history of measles, mumps or rubella infection or age
• a minimum of 4 weeks should be left between the first and second doses of MMR
• if child is less than 3 years and 4 months, give second dose of MMR with pre-school dTaP/IPV unless particular reason to give earlier
• second dose of MMR should not be given if the child is less than 18 months of age except where protection against measles is urgently required

Flu vaccine (during flu season)

• those aged 65 years and older although recommendations may change annually so always check the Annual Flu Letter
• children eligible for the current season’s childhood influenza programme (see Annual Flu Letter for date of birth range)
• those aged 6 months and older in the defined clinical risk groups (see Green Book Influenza chapter)

Human papillomavirus vaccine (HPV)

• females (born on or after 1 September 1991) and males (born on or after 1 September 2006) remain eligible for HPV vaccine up to their 25th birthday on the adolescent programme
• eligible immunocompetent individuals aged 11 to 25 years only require a single dose of HPV vaccine
• eligible individuals who are HIV positive or immunosuppressed should be offered a 3 dose schedule at 0, 1, 4 to 6 months
• for details of GBMSM HPV vaccination programme, please see Green Book HPV chapter
• any dose of Cervarix, Gardasil or Gardasil 9 would be considered valid if previously vaccinated or vaccinated abroad

Shingles vaccine

• severely immunosuppressed individuals from 50 years of age (eligibility as defined in the Green Book Shingles chapter 28a): 2 doses of Shingrix vaccine 8 weeks to 6 months apart; no upper age limit to start or complete the course
• immunocompetent individuals from their 65th and 70th birthday (see Shingles: guidance and vaccination programme for eligibility): 2 doses of Shingrix vaccine 6 months to 12 months apart. Once these individuals have become eligible, they remain eligible until their 80th birthday. The second dose of Shingrix vaccine can be given up to 81st birthday to those who have commenced but not completed the course
• immunocompetent individuals aged from 70 years who were previously eligible for shingles vaccination before 1 September 2023 should receive Zostavax (unless contraindicated) until stocks of this vaccine are exhausted, after which Shingrix should be offered

Pneumococcal polysaccharide vaccine (PPV)

• those aged 65 years and older
• those aged 2 years and older in the defined clinical risk groups (see Green Book Pneumococcal chapter)

At risk groups

Bacillus Calmette–Guérin (BCG) and hepatitis B (HepB) vaccines for those at high risk should be given as per Green Book recommendations.

Individuals in clinical risk groups may require additional vaccinations. Please check Green Book chapters.

International immunisation schedules

Information on other countries’ immunisation schedules is available from WHO.

Footnotes

1. If an individual has received any OPV in another country since April 2016, these doses should be discounted as it is unlikely that they will protect against all 3 polio types. Most countries who still use OPV have a mixed OPV and IPV schedule so if sufficient IPV doses have been received for age, no additional IPV doses are needed. ↩ ↩² ↩³ ↩⁴

2. A child who has already received one or more doses of primary diphtheria, tetanus, polio and pertussis should complete the 3 dose course with DTaP/IPV/Hib/HepB. Any missing doses of Hib and/or HepB can be given as Hib/MenC and/or, monovalent hepatitis B, at 4 week intervals. ↩

3. Doses of MenB should ideally be given 8 weeks apart. They can be given 4 weeks apart in order for the primary MenB immunisation schedule to be completed before the first birthday if possible (if schedule started after 10 months of age). ↩ ↩²

4. First dose of rotavirus vaccine to be given only if infant is more than 6 weeks and under 15 weeks and second dose to be given only if infant is less than 24 weeks old. ↩ ↩²

5. Infants who are aged 12 weeks or over when starting their primary schedule can be given their single infant priming dose of PCV13 with their first set of primary immunisations. If a child has received PCV10 vaccine abroad, they should be offered one dose of PCV13 (at least 4 weeks after PCV10 was given). ↩

6. DTaP/IPV/Hib/HepB is now the only suitable vaccine containing high dose tetanus, diphtheria and pertussis antigen for priming children of this age. Children born from 01/08/2017 who received primary vaccines without HepB should be opportunistically offered a 3 dose course of monovalent HepB vaccine. If they are in a high-risk group or are exposed to hepatitis B, they should be proactively offered a hepatitis B vaccine course. ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶

7. All un-immunised or incompletely immunised children only require one dose of Hib, Men C (until teenage booster) and PCV13 over the age of one year. It does not matter if 2 Hib-containing vaccines are given at the first appointment or if the child receives additional Hib at subsequent appointments if DTaP/IPV/Hib/HepB vaccine is given. If a child has received PCV10 vaccine abroad, they should be offered one dose of PCV13 (at least 4 weeks after PCV10 was given). ↩ ↩²

8. Children who received less than 2 doses of MenB in the first year of life should receive 2 doses of MenB in their second year of life at least 8 weeks apart. Doses of MenB can be given 4 weeks apart if necessary to ensure the 2 dose schedule is completed (if schedule started at 22 months of age). ↩ ↩²

9. All un- or incompletely immunised children only require one dose of Hib and Men C (until teenage booster) over the age of one year. It does not matter if 2 Hib-containing vaccines are given at the first appointment or if the child receives additional Hib at subsequent appointments if DTaP/IPV/Hib/HepB vaccine is given. ↩

10. Those aged from 10 years up to 25 years who have never received a MenC-containing vaccine should be offered MenACWY. Those aged 10 years up to 25 years may be eligible or may shortly become eligible for MenACWY usually given around 14 years of age. Those born on or after 1 September 1996 remain eligible for MenACWY until their 25th birthday. ↩