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Vaccine update: issue 376, September 2026

Published 23 September 2026

Applies to England

Rabies & Immunoglobulin Service (RIgS)

Who can help with all your enquiries relating to post-exposure treatment for rabies? The Rabies and Immunoglobulin Service (RIgS) provides help, advice and where appropriate, treatment for responding to travellers who have been bitten, licked or scratched by animals who may carry rabies.

RIgS is a specialist advisory service for healthcare professionals only. It is composed of nurses, doctors and administrators. RIgS undertakes post-exposure rabies risk assessments and offers specialist advice relating to patients who have potentially been exposed to a rabies susceptible animal. Following a risk assessment, RIgS can dispatch post-exposure rabies treatment directly to the healthcare professional responsible for managing medical care. RIgS performed risk assessments for over 10,000 patients in 2025, and we are on track to surpass that in 2026. To meet this demand, we have recruited additional clinical and administrative staff, restructured our teams and redefined our processes.

What is rabies?

Rabies is a virus that can be spread from any warm-blooded infected animals or bats to people through bites, scratches or exposure to infected saliva through broken skin or mucous membranes. All warm-blooded animals, such as dogs, cats, monkeys, bats and other wildlife, can catch rabies. It is spread through the saliva of an infected animal, with dog bites being the cause of more than 99% of human rabies deaths.

Post-exposure rabies treatment (i.e. rabies vaccine with or without rabies immunoglobulin) is highly effective if given correctly and promptly after exposure, therefore post-exposure rabies treatment is potentially life-saving treatment.

The Post-Exposure Rabies Risk Assessment

Our standard advice for all patients who have been bitten, scratched or licked by an animal whilst overseas is that they should seek and follow local medical guidance in the country of exposure and contact their General Practitioner on return to England. The arrangements for specialist advice and provision of PET differ between England, Scotland, Wales, and Northern Ireland.

Bat bites can be difficult to identify because they may be felt rather than seen and may not draw blood.

To simplify and speed up this process, health professionals are asked to gather as much of the following information as possible before contacting RIgS:

• date of exposure
• species of the animal involved and, if feasible, its current health status
• the country the exposure occurred in
• specific details of the bite or other exposure, is the wound still visible?
• the bodily (anatomical) site(s) of the exposure
• is the patient immunosuppressed
• does the patient have any allergies/clinical information
• has the patient received rabies vaccines in the past, before this exposure
• what rabies vaccinations or rabies immunoglobulin treatment has already been given following the exposure (including dates, vaccine, and route)
• weight of the patient (in case rabies immunoglobulin is being considered)

The risk assessment will consider the rabies risks associated with the country and type of animal involved, along with a categorisation of the exposure to calculate a Composite Rabies Risk (red/amber/green). The post-exposure rabies treatment that patient needs will be based on this Composite Rabies Risk, the patient’s medical history, and whether the patient has had rabies vaccine in the past.

Further information on the revised rabies risk assessment process can be found in the Rabies Green Book chapter and in UKHSA’s rabies post-exposure treatment management guidelines.

Unimmunised patients who were bitten by an animal in a high-risk country would usually receive a course of four rabies vaccines with or without Human Rabies Immunoglobulin on days 0, 3, 7 and 21.

Composite risk	Unimmunised
Green	No treatment
Amber	4 vaccine doses: day 0, day 3, day 7 and day 21
Red	HRIG + 4 vaccine doses: day 0, day 3, day 7 and day 21 HRIG has timing instructions

The need for human rabies immunoglobulin will depend on the specific details of the patient’s risk assessment. To facilitate prompt rabies post-exposure treatment for patients, local NHS services are encouraged to provide access to a small number of doses of rabies vaccine to initiate a course. Any vaccine held locally that is used for post-exposure rabies treatment will be replaced free of charge if the RIgS team are contacted on the next working day.

Severely immunosuppressed patients

Patients who are severely immunosuppressed may not respond adequately to rabies vaccination. The UKHSA 2023 Guidelines on rabies post-exposure treatment recommend that severely immunosuppressed patients with a significant exposure receive:

HRIG + five doses of rabies vaccine on: Day 0 > Day 3 > Day 7 > Day 14 > Day 30

Antibody testing is also recommended to confirm the patient’s response to treatment.

These patients require particular attention and specialist advice.

Administration of Human Rabies Immunoglobulin (HRIG)

Rabies vaccine is the mainstay of rabies post-exposure treatment, but human rabies immunoglobulin (HRIG) may be advised as part of the post-exposure treatment for higher risk wounds.

HRIG contains rabies antibodies that have been obtained from the plasma of immunised and screened human donors from outside the UK. It is used to provide short term passive immunity by neutralising the rabies virus at the wound site until the rabies vaccine becomes effective. The rabies antibody level produced by vaccination is much greater than that provided by HRIG so there is benefit in HRIG administration as part of the initial management of certain exposures. The current guidance says HRIG is not indicated more than 7 days after the first vaccine or more than 1 day after the second rabies vaccine dose or for a partially immunised individual, unless immunosuppressed. The Interim guidelines also state that HRIG is not indicated if an exposure occurred more than 1 month ago or if the wound is no longer visible.

To be effective, HRIG must be infiltrated into and around the wound where possible rather than being given as an intramuscular injection. The benefit of intramuscular administration away from the site of the bite or laceration is likely to be negligible. Rabies vaccine and human rabies immunoglobulin should not be given at the same anatomical site.

Current treatment recommendations are that children under 16, immunosuppressed patients and people who have been exposed to an animal that is confirmed to be rabid should receive a dosage of HRIG that is based on their bodyweight. The maximum recommended dose of HRIG is 20IU/kg. Giving too much HRIG may interfere with the ability to mount an antibody response to the vaccine.

As per our Interim guidelines, immunocompetent patients over the age of 16 years will require one vial of HRIG infiltrated to the bite site(s). Patients who were exposed more than one month ago, or who no longer have a visible wound, do not require HRIG (unless they are immunosuppressed or they were exposed to an animal that is confirmed to be rabid).

HRIG is different from other immunoglobulins that you might have administered before, as a specific volume should be administered and not necessarily the full contents of all vials provided. When HRIG is issued from UKHSA for your patient, the volume that should be administered will be calculated for you and included in the risk assessment paperwork. The quantity of HRIG noted on the packaging is the minimum content of the vial.

Contacting RIgS

RIgS operates 7 days per week. Our routine hours are 9:30am to 5pm. After this time, the emergency out of hours service is only able to deal with calls about potential human cases or the highest risk rabies exposures who have not already received one post-exposure dose of rabies vaccine (these are exposures to the head or neck, or to an animal that is confirmed to have rabies).

Healthcare professionals calling about any other rabies exposures should administer a dose of rabies vaccine if the patient has not yet received any rabies vaccine (or if the next scheduled dose is due) and vaccine is available locally and call back the next day after 9:30am to complete the risk assessment and confirm the timings for further vaccine doses.

This service only provides advice to healthcare professionals who can then take responsibility to arrange the administration of vaccine or immunoglobulin in line with that advice.

Need Advice? Contact RIgS

Healthcare professionals only: 0330 128 1020. 9:30am – 5pm, 7 days a week.

Outside routine hours, the emergency service should be contacted for potential human rabies exposure or the highest-risk exposures where the patient has not yet received their first post-exposure vaccine dose.

Email: phe.ig.clerks@nhs.net (for non-urgent enquiries only)

RIgS resources

• Interim recommendations for human rabies immunoglobulin (HRIG) use
• RIgS Guidelines on rabies post-exposure treatment (January 2023)
• the Green Book – Rabies chapter
• Rabies post-exposure risk assessment poster
• Rabies information leaflet

New: toolkit to support action on immunisation inequities

Reducing immunisation inequities is essential to improve vaccine uptake and protect communities from vaccine-preventable disease. While overall vaccination coverage in England remains high by international standards, significant differences persist between population groups and geographical areas.

To support local action, UKHSA has published Understanding and addressing immunisation inequities: a practical toolkit for a collaborative, multi-agency approach. A deliverable of the UKHSA Immunisation Equity Strategy 2025 to 2030, this toolkit is designed to help local and regional stakeholders, including integrated care boards and local authorities, to understand and act on immunisation inequities in the populations they serve.

The toolkit is built around an immunisation equity cycle in 5 steps:

1. Preparation: build the foundations – establish governance, roles and resources for immunisation equity work.
2. Situational analysis: understand the problem – review data to identify inequities in vaccination uptake and understand behavioural and structural drivers.
3. Planning and co-design: develop the best solution – partner with communities to develop targeted interventions.
4. Implementation: intervene to reduce inequities – deliver interventions to reduce immunisation inequities.
5. Evaluation and refinement: determine what did and didn’t work – continuously monitor process and outcome indicators to identify areas for intervention refinement.

This resource draws together existing evidence, recommendations, local practice examples and expert opinion on effective approaches to planning and delivering equitable immunisation programmes. Applying the approaches outlined in the toolkit can help local systems take a more systematic and evidence-based approach to reducing inequities and increasing vaccine uptake across population subgroups.

New: vaccination of individuals with uncertain or incomplete immunisation status supporting guidance

A guidebook to support the use of the Vaccination of individuals with uncertain or incomplete immunisation algorithm from UKHSA with worked examples and FAQs for health professionals.

View on .GOV.UK along with the latest version of the algorithm.

Download or order from Find Public Health Resources, product code: 126546AAEN001.

Save the date for the 14th annual National Immunisation Network Conference 2027

Tuesday 15 and Wednesday 16 of June 2027

London, Park Plaza Hotel Victoria, 239 Vauxhall Bridge Rd, Pimlico, London SW1V 1EQ

Website will be launched later this year. The theme for this year will be announced when the event website is launched and will focus on data driven developments in vaccines across the life course and their wider economic and societal impact. Experts in the field will update on the data and scientific evidence used to drive improvements to the national programme, and in the evaluation, implementation and uptake of vaccines.

Day 1

A strong scientific focus and will include hot topic sessions on significant exciting new developments and new vaccines used in the routine and selective immunisation programmes.

Day 2

An operational and implementation focus, including sharing of innovative developments and successes in programme delivery.

Watch highlights from 2026’s NIN conference.

For any enquiries, you can email NIN2020@UKHSA.gov.uk.

Routine vaccine supply

Pneumococcal vaccination for people experiencing homelessness (PEH)

From 01 October 2026, there will be an expansion in the eligibility for pneumococcal vaccination to include people experiencing homelessness (PEH). Details of this expansion in England have been published in the People experiencing homelessness eligible for pneumococcal vaccination letter.

The current Prevenar 20® vaccine will be used for this expansion of the pneumococcal vaccination programme and is available to order by customers for delivery on the customer’s scheduled delivery day.

Ordering controls will be in place for all customers to reduce the risk of ordering errors. These are not intended to restrict activity.

The ten-dose pack of Prevenar 20® vaccine measures 99 mm x 62 mm x 123 mm (H x W x D). Customers placing large orders should order in multiples of 12 ten-dose packs (the number in a shipper). Please ensure you have enough fridge capacity before placing any orders as returns cannot be accepted.

Prevenar 20® vaccine supplied by UKHSA is a ten-dose pack, containing ten pre-filled syringes and ten patient information leaflets (PIL). The ten-dose pack of Prevenar 20® vaccine supplied by UKHSA does not contain needles for administration. Guidance on the choice of needle size can be found here – Green Book Chapter 4. Needles should be obtained locally.

To minimise wastage due to fridge failures, please only order vaccine required for 2 to 4 weeks’ worth of booked appointments. Further guidance can be found here: Green Book Chapter 3 – Storage, distribution and disposal of vaccines.

ImmForm customers can contact helpdesk@immform.org.uk for ordering queries.

Non-ImmForm customers should refer to their local ordering guidance.

Details about pneumococcal vaccination can be found at Green Book: Pneumococcal chapter.

Further details about Prevenar 20® vaccine can be found at Prevenar 20 suspension for injection in pre-filled syringe - SmPC.

RSV vaccination expanded eligibility

From 01 September 2026, there will be an expansion in the eligibility for RSV vaccination to include adults aged 65 to 74 years in certain clinical risk groups. Details of this expansion in England have been published here – Expansion of eligibility to adults aged 65 to 74 years in certain clinical at-risk groups letter. The current Abrysvo® vaccine will be used for this expansion of the RSV vaccination programme and is available to order by customers for delivery on the customer’s scheduled delivery day.

Ordering controls will be in place for all customers to reduce the risk of ordering errors. These are not intended to restrict activity.

For customers in Scotland and Wales, bespoke ordering controls will be in place to manage the numbers of pallets transiting through local pinch points in the supply chain. These controls are unchanged from the expansion that took place earlier this year to those aged 80 years and older and residents in care homes for older adults. To help protect the supply chain, customers in Scotland and Wales should consider placing their orders for delivery over several weeks in advance of the start of this expansion, using ImmForm’s deferred order function to assist.

The pack of Abrysvo® vaccine measures 73 mm x 35 mm x 116 mm (H x W x D) and is bigger than most other packs of vaccine. Customers placing large orders should order in multiples of 50 packs (the number in a shipper), or 1,800 packs (the number on a pallet). Please ensure you have enough fridge capacity before placing any orders as returns cannot be accepted.

Abrysvo® vaccine supplied by UKHSA is a single-dose pack, containing the components required to reconstitute one dose of vaccine and one patient information leaflet (PIL). The single-dose pack of Abrysvo® vaccine supplied by UKHSA does not contain needles for administration. Guidance on the choice of needle size can be found here – Green Book Chapter 4. Needles should be obtained locally.

A poster with details of how to reconstitute and recycle the components of an Abrysvo® vaccine can be downloaded here – Abrysvo vaccine reconstitution and recycling from Pfizer UK.

To minimise wastage due to fridge failures, please only order vaccine required for 2 to 4 weeks’ worth of booked appointments. Further guidance can be found here: Green Book Chapter 3 – Storage, distribution and disposal of vaccines.

ImmForm customers can contact helpdesk@immform.org.uk for ordering queries.

Non-ImmForm customers should refer to their local ordering guidance.

Details about RSV vaccination can be found here – Green Book RSV chapter.

Further details about Abrysvo® vaccine can be found here – Abrysvo powder and solvent for solution for injection – Summary of Product Characteristics.

Vaccines for the 2026/27 children’s flu programme supplied by UKHSA

All vaccines are now available to order

The latest and most accurate information on all vaccines for the 2026/27 children’s flu programme supplied by UKHSA will be provided on the ImmForm news page so please check back regularly.

Vaccines and availability

All flu vaccines supplied to general practice (GPs) and the school age immunisation service (SAIS) in England for the 2026/27 children’s flu programme are available to order via ImmForm. The 2 vaccines that are available and the groups that these vaccines should be ordered for are set out in the table below.

Community pharmacies who are delivering flu vaccinations to children can access Fluenz® (LAIV) via the Federated Data Platform managed by NHS England. For more information please see the amendment to the annual flu letter and the service specification.

UKHSA does not supply any flu vaccines for patients aged 18 years and over.

Please refer to guidance from your respective health departments for arrangements in Scotland, Wales and Northern Ireland.

Vaccine	Manufacturer	Available to order for
Fluenz® (LAIV)	AstraZeneca	All children from 2 years of age to school year 11 Children in clinical risk groups aged 2 to <18 years (note 1)
Cell Based Trivalent Influenza Vaccine (Surface Antigen, Inactivated) (IIVc)	Seqirus	Children in clinical risk groups aged 6 months to <2 years Children aged from 2 to <18 years old in clinical risk groups for whom LAIV is clinically contraindicated or otherwise unsuitable Healthy children from 2 years old to those in school year 11, for whom LAIV is unsuitable (note 2)

Note 1: unless LAIV clinically contraindicated or otherwise unsuitable

Note 2: for example, due to objection to LAIV on the grounds of its porcine gelatine content

LAIV ordering information for general practice

Ordering controls will be in place for general practices, to enable UKHSA to balance supply with demand. These controls will work by allocating an amount of LAIV based on the number of registered eligible patients and will be tailored to each practice.

UKHSA expects to be able to accommodate the following, however at this time, this information remains subject to change:

• each GP practice will initially be allocated sufficient LAIV to vaccinate at least 45% of their eligible patients (all 2 and 3 year-olds, plus children in clinical risk groups from age 4 to <18 years) when ordering commences
• increases to these allocations will be made in response to demand and vaccine availability
• requests for extra vaccine will be considered on a case-by-case basis throughout the ordering period - requests for additional vaccine should be sent to the helpdesk (helpdesk@immform.org.uk) and should be sent in good time before your order cut-off
• out of schedule deliveries will be by exception only

Allocations

You can view how many packs of LAIV your practice has available to order by clicking on the following link to the Allocation report (you will be asked to log in with your ImmForm credentials).

You will then need to select:

• Allocations; followed by
• Products available to order (Allocation managed) report

Please note that this report is not updated in real-time and so may not account for any orders or allocation amendments made within the last 30-45 minutes.

Multi-branch practices and LAIV allocations

GP practices or groups that operate over multiple sites but are part of the same organisation will have a joint allocation (as in previous years), even where each site has a unique ImmForm account. This means that it is possible for one site to potentially order all of the available vaccine for the group, unless there is local agreement on how the allocated volume is shared. UKHSA recommend that this agreement is in place before ordering opens to reduce the risk of supply interruption. The information above allows practices to estimate the amount of vaccine they will be initially allocated, and how it should be split between all sites.

LAIV ordering information for SAIS providers

Please note the default weekly ordering cap for SAIS teams has been reduced from 450 packs (4,500 doses), to 432 packs (4,320 doses).

This adjustment has been made to increase efficiency, allowing for fewer deliveries in fewer vehicles, and a reduction in our carbon footprint.

Where the default cap is insufficient and a provider needs a larger weekly volume of vaccine to deliver the programme (for example where a provider covers a large area using a single account), a higher weekly cap should be requested via the UKHSA Flu Vaccine Operations team by emailing childfluvaccine@ukhsa.gov.uk, please provide your ImmForm account number or Org Code and the increased volume required. Requests should be made by Friday 21 August to ensure that accounts are set up correctly before vaccine ordering commences.

For one-off larger orders during the ordering period, requests should be made via helpdesk@immform.org.uk.

Inactivated flu vaccine ordering

The Cell Based Trivalent Influenza Vaccine (Surface Antigen, Inactivated) (IIVc) will be available to order, in a single dose pack. Order controls will also be in place for this vaccine as follows:

• for GPs, there will be an initial cap of 10 doses/packs per week
• for school-age providers, there will be a cap of 450 doses/packs per week

Influenza vaccines for the 2026/27 season

Information on all influenza vaccines that will be marketed in the UK for the 2026/27 season are available on GOV.UK.

Promotional materials

Promotional resources including posters, leaflets and stickers to support the 2026/27 children’s flu vaccination programme are available on .GOV.UK.

ProQuad® (MMRV) vaccine temporarily unavailable to order

UKHSA continually monitors vaccine stock levels across the national immunisation programme to ensure sufficient supply is available to support routine and catch-up vaccination activity.

To support the efficient management of MMRV vaccine stocks and minimise the risk of vaccine wastage, ordering of ProQuad® vaccine through ImmForm will be temporarily suspended during August and September 2026. Customers requiring MMRV vaccine should order Priorix-Tetra® instead.

Priorix-Tetra® vaccine will remain available to order throughout this period. This is a temporary stock management measure and is not intended to impact routine vaccination activity.

Priorix-Tetra® vaccine is interchangeable with ProQuad® vaccine. Children who started their 2 dose MMRV schedule with one vaccine brand can complete the course with the other brand.

The 10 dose pack of Priorix-Tetra® vaccine supplied by UKHSA contains 10 single-dose vials of vaccine powder, 10 pre-filled syringes of diluent and one patient information leaflet (PIL). Each ten-dose pack of Priorix-Tetra® vaccine supplied by UKHSA will be delivered with a pad of 10 additional PILs. Packs of Priorix-Tetra® vaccine do not contain needles for administration.

Further details about Priorix-Tetra® vaccine can be found here – Priorix Tetra Powder and solvent for solution for injection in pre-filled syringe – Summary of Product Characteristics.

Guidance on the choice of needle size can be found here – Green Book Chapter 4. Needles should be obtained locally.

To help with planning storage requirements, the dimensions of each larger ten-dose pack of Priorix-Tetra® vaccine are 142 x 178 x 29 mm (H x W x D).

To minimise wastage due to fridge failures, please only order vaccine required for 2 to 4 weeks’ worth of booked appointments. Further guidance can be found here: Green Book Chapter 3 – Storage, distribution and disposal of vaccines. ImmForm customers can contact helpdesk@immform.org.uk for ordering queries.

Northern Ireland customers

Non-ImmForm customers should refer to their local ordering guidance.

Non-routine vaccine supply

Hepatitis A vaccine

Adult

• GSK: supply of Havrix Adult PFS singles and packs of 10 are currently available
• Sanofi Pasteur: Avaxim PFS singles are currently available. Avaxim packs of 10 are currently available
• MSD: VAQTA Adult is available

Paediatric

• GSK: supply of Havrix Paediatric singles and packs of 10 are currently available
• MSD: VAQTA Paediatric is available
• Sanofi Pasteur: Avaxim Junior singles are currently available

Hepatitis B vaccine

Adult

• GSK: Engerix B PFS singles and packs of 10 are currently available
• GSK: Supply of Fendrix is currently available
• MSD: HBVAXPRO 10 µg is available
• MSD: HBVAXPRO 40 µg is available
• Valneva: PreHevbri is no longer marketed in the UK

Paediatric

• GSK: Supplies of Engerix B Paediatric singles are currently available
• MSD: HBVAXPRO 5µg is available

Combined hepatitis A and B vaccine

• GSK: Twinrix Adult singles and packs of 10 are available
• GSK: Twinrix Paediatric is currently available
• GSK: Ambirix is available

Combined hepatitis A and typhoid vaccine

• Sanofi Pasteur: Viatim is now a discontinued product and no longer available for sale

Typhoid vaccine

• Sanofi Pasteur: Typhim singles and packs of 10 are available
• Bavarian Nordic: Vivotif is available

Rabies vaccine

• Bavarian Nordic: Rabipur is currently available
• Sanofi Pasteur: Verorab is available to order with some restrictions

Pneumococcal polysaccharide vaccine (PPV)

• MSD: Private supply of Pneumovax 23 (PPV23) PFS discontinued November 2025

Pneumococcal polysaccharide conjugate vaccine (PCV)

• Pfizer: Prevenar 13 is currently available
• Pfizer: Prevenar 20 is currently available
• MSD: Vaxneuvance is currently available
• MSD: Capvaxive®▼ is currently available

Varicella zoster vaccine

• GSK: VARILRIX is available
• MSD: VARIVAX is available
• MSD: ZOSTAVAX is a discontinued product

Diphtheria, tetanus and poliomyelitis (inactivated) vaccine

• Sanofi Pasteur: Revaxis is available

Diphtheria, tetanus, pertussis (acellular) and poliomyelitis (inactivated) vaccine

• GSK: Supply of Boostrix-IPV is currently available
• Sanofi Pasteur: Repevax is currently available

MMR

• MSD: MMR Vaxpro is currently available
• GSK: Priorix is currently available

Meningitis ACWY vaccine

• GSK: Menveo is currently available
• Pfizer: Nimenrix is currently available
• Sanofi Pasteur: MenQuadfi is available  

Yellow fever

• Sanofi Pasteur: Stamaril is available to order without restrictions

Human papillomavirus vaccine

• MSD: Gardasil 9 is currently available
• GSK: Cervarix has been discontinued

Cholera vaccine

• Valneva: Dukoral is available
• Bavarian Nordic: Vaxchora is available

Japanese encephalitis vaccine

• Valneva: Ixiaro is currently out of stock until w/e 18th of September

Meningococcal group B vaccine

• GSK: Supply of Bexsero is available

Diphtheria, tetanus, pertussis, Hib vaccine and poliomyelitis

• GSK: Infanrix IPV+Hib is currently available

Live attenuated rotavirus vaccine

• GSK: Rotarix is currently available

Herpes zoster vaccine

• GSK: Supply of Shingrix is currently available

Diphtheria, tetanus and pertussis

• Sanofi Pasteur: Adacel is currently available

Dengue tetravalent vaccine

• Takeda: Qdenga is currently available

Respiratory syncytial virus vaccine

• Pfizer: Abrysvo is currently available
• GSK: Arevxy is currently available

Chikungunya vaccine

• Valneva: IXCHIQ®▼ is out of stock
• Bavarian Nordic: Vimkunya®▼ is available

Clesrovimab

• MSD: Enflonsia▼ is currently available

COVID-19 mRNA vaccine

• Pfizer: COMIRNATY®▼XFG (mRNA encoding XFG) is currently available