6 months and over with the following conditions:

. chronic respiratory disease;

. chronic heart disease;

. chronic liver disease;

. chronic renal disease at stage 3, 4 or 5;

. chronic neurological disease;

. complement disorders;

. diabetes mellitus;

. immunosuppression because of disease (including

asplenia or splenic dysfunction) or treatment (including

prolonged systemic corticosteroid treatment [for over

1 month at dose equivalents of prednisolone p. 678: adult

and child over 20 kg, 20 mg or more daily; child under 20 kg,

1 mg/kg or more daily], and chemotherapy);

. HIV infection (regardless of immune status);

. morbid obesity (BMI of 40 kg/m2 and above).

Annual influenza vaccine is also recommended for:

. children of specific ages, see Immunisation schedule

p. 1296;

. all pregnant women (including those who become

pregnant during the flu season);

. all adults aged 65 years and over (including those

becoming 65 by 31 March 2020);

. residents of nursing or residential homes for the elderly

and other long-stay facilities;

. carers of individuals whose welfare may be at risk if the

carer falls ill;

. household contacts of immunocompromised individuals;

. frontline health and social care workers.

Children aged 6 months to less than 2 years of age in

clinical risk groups should be offered the standard egggrown quadrivalent inactivated influenza vaccine.

Children aged 2–17 years of age (including those in clinical

risk groups) should be offered the live attenuated influenza

vaccine, administered as a nasal spray (Fluenz tetra ®). The

live attenuated vaccine is thought to provide broader

protection than inactivated vaccines. If the child is in a

clinical risk group and the live attenuated vaccine is contraindicated or otherwise unsuitable, offer standard egg-grown

quadrivalent inactivated influenza vaccine.

Children aged 6 months to less than 9 years of age in

clinical risk groups who have not had the influenza vaccine

previously should be offered two doses of the appropriate

influenza vaccine, four weeks apart.

Adults aged 18 to 64 years of age in clinical risk groups,

pregnant females, and other eligible groups should be

offered either the standard egg-grown quadrivalent

inactivated influenza vaccine or the cell-grown quadrivalent

inactivated influenza vaccine.

Adults aged 65 years and over should be offered either the

adjuvanted trivalent inactivated influenza vaccine or the

cell-grown quadrivalent inactivated influenza vaccine. The

high dose trivalent inactivated influenza vaccine is equally

suitable but is not eligible for reimbursement under the

NHS flu vaccination 2019/2020 programme .

In the 2019/2020 national influenza immunisation

programme, annual influenza vaccine will be offered to all

children aged 2–10 years on 31st August 2019 (including

those in reception class and school years 1, 2, 3, 4, 5, and 6).

For the management of influenza, see Influenza p. 661.

Information on pandemic influenza, avian influenza,

swine influenza, and annual flu programme may be found at

www.gov.uk/government/collections/pandemic-flu-public-healthresponse and at www.gov.uk/government/collections/annual-fluprogramme.

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Useful Resources

Recommendations reflect Chapter 19, Influenza, in

Immunisation against infectious disease– ‘The Green Book’.

Public Health England. April 2019.

www.gov.uk/government/publications/influenza-the-green-bookchapter-19

‘National flu immunisation programme plan 2019/2020’

Public Health England, Department of Health and Social

Care, and NHS England. March 2019.

www.gov.uk/government/publications/national-flu-immunisationprogramme-plan

Japanese encephalitis vaccine 14-Nov-2018

Overview

Japanese encephalitis is a mosquito-borne viral encephalitis

caused by a Flavivirus.

Japanese encephalitis vaccine p. 1323 (IXIARO) ® is an

inactivated vaccine adsorbed onto an adjuvant. It is

recommended for individuals who are going to reside in an

area where Japanese encephalitis is endemic or epidemic.

Travellers to South and South-East Asia and the Far East

should be immunised if staying for a month or longer in

endemic areas during the transmission season. Other

travellers with shorter exposure periods should also be

immunised if the risk is considered sufficient. Immunisation

is also recommended for laboratory staff at risk of exposure

to the virus.

The primary immunisation course of 2 doses should be

completed at least one week before potential exposure to

Japanese encephalitis virus.

In adults (aged under 65 years) and children (aged

2 months and over) at ongoing risk (including laboratory

staff and long-term travellers), a single booster dose should

be given 12 months after the primary immunisation course.

A booster dose can be considered in adults aged 65 years and

over, but the immune response is lower than in younger

adults. For other travellers, a single booster dose should be

given within 12–24 months after primary immunisation,

before potential re-exposure to the Japanese encephalitis

virus. Travellers aged 18–64 years should be offered a second

booster dose at 10 years if they remain at risk.

Cases of Japanese encephalitis should be managed with

supportive treatment.

Up-to-date information on the risk of Japanese

encephalitis in specific countries can be obtained from the

National Travel Health Network and Centre.

Useful Resources

Recommendations reflect Chapter 20, Japanese encephalitis,

in Immunisation against infectious disease– ‘The Green book’.

Public Health England, June 2018.

www.gov.uk/government/publications/japanese-encephalitis-thegreen-book-chapter-20

National Travel Health Network and Centre

nathnac.net

Measles, Mumps and Rubella

vaccine

Overview

Measles vaccine has been replaced by a combined measles,

mumps and rubella vaccine, live p. 1323 (MMR vaccine).

Measles, mumps and rubella vaccine, live aims to

eliminate measles, mumps, and rubella (German measles)

and congenital rubella syndrome. Every child should receive

two doses of measles, mumps and rubella vaccine, live by

entry to primary school, unless there is a valid contraindication. Measles, mumps and rubella vaccine, live should

be given irrespective of previous measles, mumps, or rubella

infection or vaccination.

The first dose of measles, mumps and rubella vaccine, live

is given to children at 1 year of age, on or after their first

birthday. A second dose is given before starting school at

3 years and 4 months of age, or soon after (see Immunisation

Schedule).

Children presenting for pre-school booster who have not

received the first dose of measles, mumps and rubella

vaccine, live should be given a dose of measles, mumps and

rubella vaccine, live followed 3 months later by a second

dose.

At school-leaving age or at entry into further education,

measles, mumps and rubella vaccine, live immunisation

should be offered to individuals of both sexes who have not

received 2 doses during childhood. In those who have

received only a single dose of measles, mumps and rubella

vaccine, live in childhood, a second dose is recommended to

achieve full protection. If 2 doses of measles, mumps and

rubella vaccine, live are required, the second dose should be

given one month after the initial dose. The decision on

whether to vaccinate adults should take into consideration

their vaccination history, the likelihood of the individual

remaining susceptible, and the future risk of exposure and

disease.

Measles, mumps and rubella vaccine, live should be used

to protect against rubella in seronegative women of childbearing age (see Immunisation Schedule); unimmunised

healthcare workers who might put pregnant women and

other vulnerable groups at risk of rubella or measles should

be vaccinated. Measles, mumps and rubella vaccine, live may

also be offered to previously unimmunised and seronegative

post-partum women (see measles, mumps and rubella

vaccine, live)—vaccination a few days after delivery is

important because about 60% of congenital abnormalities

from rubella infection occur in babies of women who have

borne more than one child. Immigrants arriving after the age

of school immunisation are particularly likely to require

immunisation.

Contacts

Measles, mumps and rubella vaccine, live may also be used

in the control of outbreaks of measles and should be offered

to susceptible children aged over 6 months who are contacts

of a case, within 3 days of exposure to infection. Children

immunised before 12 months of age should still receive two

doses of measles, mumps and rubella vaccine, live at the

recommended ages. If one dose of measles, mumps and

rubella vaccine, live has already been given to a child, then

the second dose may be brought forward to at least one

month after the first, to ensure complete protection. If the

child is under 18 months of age and the second dose is given

within 3 months of the first, then the routine dose before

starting school at 3 years and 4 months of age (or soon after)

should still be given. Children aged under 9 months for

whom avoidance of measles infection is particularly

important (such as those with history of recent severe

illness) can be given normal immunoglobulin after exposure

to measles; routine measles, mumps and rubella vaccine, live

immunisation should then be given after at least 3 months at

the appropriate age.

Measles, mumps and rubella vaccine, live is not suitable

for prophylaxis following exposure to mumps or rubella

since the antibody response to the mumps and rubella

components is too slow for effective prophylaxis.

Children and adults with impaired immune response

should not receive live vaccines (see advice on HIV). If they

have been exposed to measles infection they should be given

normal immunoglobulin.

Travel

Unimmunised travellers, including children over 6 months,

to areas where measles is endemic or epidemic should

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receive measles, mumps and rubella vaccine, live. Children

immunised before 12 months of age should still receive two

doses of measles, mumps and rubella vaccine, live at the

recommended ages. If one dose of measles, mumps and

rubella vaccine, live has already been given to a child, then

the second dose should be brought forward to at least one

month after the first, to ensure complete protection. If the

child is under 18 months of age and the second dose is given

within 3 months of the first, then the routine dose before

starting school at 3 years and 4 months of age (or soon after)

should still be given.

Useful Resources

Advice reflects that in the handbook Immunisation against

Infectious Disease (2013), which in turn reflects the guidance

of the Joint Committee on Vaccination and Immunisation

(JCVI). The advice also incorporates changes announced by

the Chief Medical Officer and Health Department Updates.

Chapters from the handbook (including updates since 2013)

are available at:

www.gov.uk/government/collections/immunisation-againstinfectious-disease-the-green-book

Meningococcal vaccine

Overview

Almost all childhood meningococcal disease in the UK is

caused by Neisseria meningitidis serogroups B and C.

Meningococcal group C conjugate vaccine protects only

against infection by serogroup C and Meningococcal group

B vaccine protects only against infection by serogroup B.

The risk of meningococcal disease declines with age—

immunisation is not generally recommended after the age of

25 years.

Tetravalent meningococcal vaccines that cover serogroups

A, C, W135, and Y are available. Although the duration of

protection has not been established, the meningococcal

groups A, C, W135, and Y conjugate vaccine is likely to

provide longer-lasting protection than the unconjugated

meningococcal polysaccharide vaccine. The antibody

response to serogroup C in unconjugated meningococcal

polysaccharide vaccines in young children may be

suboptimal [not currently available in the UK].

Meningococcal group B vaccines, Bexsero ®, and

Trumenba ® are licensed in the UK against infection caused

by Neisseria meningitidis serogroup B. The use of Bexsero ® is

recommended in the Immunisation Schedule. Bexsero ®

contains 3 recombinant Neisseria meningitidis serogroup B

proteins and the outer membrane vesicles from the NZ

98/254 strain, in order to achieve broad protection against

Neisseria meningitidis serogroup B. Trumenba ® contains 2

recombinant Neisseria meningitidis serogroup B proteins. The

proteins are adsorbed onto an aluminium compound to

stimulate an enhanced immune response.

Childhood immunisation

Meningococcal group C conjugate vaccine provides longterm protection against infection by serogroup C of Neisseria

meningitidis. Immunisation consists of 1 dose given at

12 months of age (as the haemophilus influenzae type b with

meningococcal group C vaccine p. 1314) and a second dose

given at 13–15 years of age (as the meningococcal groups A

with C and W135 and Y vaccine p. 1315) (see Immunisation

Schedule).

Meningococcal group B vaccine provides protection

against infection by serogroup B of Neisseria meningitidis.

Immunisation consists of 1 dose given at 2 months of age, a

second dose at 4 months of age, and a booster dose at

12 months of age (see Immunisation Schedule above).

Unimmunised children aged under 12 months should be

given 1 dose of meningococcal group B vaccine (rDNA,

component, adsorbed) p. 1314 followed by a second dose of

meningococcal group B vaccine (rDNA, component,

adsorbed) two months later. They should then be vaccinated

according to the Immunisation Schedule (ensuring at least a

two month interval between doses of meningococcal group B

vaccines). Unimmunised children aged 12–23 months should

be given 2 doses of meningococcal group B vaccine (rDNA,

component, adsorbed) separated by an interval of two

months if they have received less than 2 doses in the first

year of life. Unimmunised children aged 2–9 years should be

given a single dose of meningococcal group C vaccine (as the

haemophilus influenzae type b with meningococcal group C

vaccine) followed by a booster dose of meningococcal groups

A with C and W135 and Y vaccine at 13–15 years of age.

From 2015, unimmunised individuals aged 10–25 years,

including those aged under 25 years who are attending

university for the first time, should be given a single dose of

meningococcal groups A with C and W135 and Y vaccine; a

booster dose is not required.

Patients under 25 years of age with confirmed serogroup C

disease, who have previously been immunised with

meningococcal group C vaccine, should be offered

meningococcal group C conjugate vaccine before discharge

from hospital.

Travel

Individuals travelling to countries of risk should be

immunised with meningococcal groups A, C, W135, and Y

conjugate vaccine, even if they have previously received

meningococcal group C conjugate vaccine. If an individual

has recently received meningococcal group C conjugate

vaccine, an interval of at least 4 weeks should be allowed

before administration of the tetravalent (meningococcal

groups A, C, W135, and Y) vaccine.

Vaccination is particularly important for those living or

working with local people or visiting an area of risk during

outbreaks.

Immunisation recommendations and requirements for

visa entry for individual countries should be checked before

travelling, particularly to countries in Sub-Saharan Africa,

Asia, and the Indian sub-continent where epidemics of

meningococcal outbreaks and infection are reported.

Country-by-country information is available from the

National Travel Health Network and Centre (www.nathnac.

org/).

Proof of vaccination with the tetravalent meningococcal

groups A with C and W135 and Y vaccine is required for

those travelling to Saudi Arabia during the Hajj and Umrah

pilgrimages (where outbreaks of the W135 strain have

occurred).

Contacts

For advice on the immunisation of laboratory workers and

close contacts of cases of meningococcal disease in the UK

and on the role of the vaccine in the control of local

outbreaks, consult Guidance for Public Health Management

of Meningococcal Disease in the UK at www.gov.uk/phe. Also

see for antibacterial prophylaxis for prevention of secondary

cases of meningococcal meningitis.

The need for immunisation of laboratory staff who work

directly with Neisseria meningitidis should be considered.

Useful Resources

Advice reflects that in the handbook Immunisation against

Infectious Disease (2013), which in turn reflects the guidance

of the Joint Committee on Vaccination and Immunisation

(JCVI). The advice also incorporates changes announced by

the Chief Medical Officer and Health Department Updates.

Chapters from the handbook (including updates since 2013)

are available at:

www.gov.uk/government/collections/immunisation-againstinfectious-disease-the-green-book

BNF 78 Vaccination 1303

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Pertussis vaccine

Overview

Pertussis vaccine is given as a combination preparation

containing other vaccines. Acellular vaccines are derived

from highly purified components of Bordetella pertussis.

Primary immunisation against pertussis (whooping cough)

requires 3 doses of an acellular pertussis-containing vaccine

(see Immunisation schedule), given at intervals of 1 month

from the age of 2 months.

All children up to the age of 10 years should receive

primary immunisation with a combination vaccine of

diphtheria with tetanus, pertussis, hepatitis B, poliomyelitis

and haemophilus influenzae type b vaccine p. 1312 (Infanrix

hexa ®).

A booster dose of an acellular pertussis-containing vaccine

should ideally be given 3 years after the primary course,

although, the interval can be reduced to 1 year if the primary

course was delayed. Children aged 1–10 years who have not

received a pertussis-containing vaccine as part of their

primary immunisation should be offered 1 dose of a suitable

pertussis-containing vaccine; after an interval of at least

1 year, a booster dose of a suitable pertussis-containing

vaccine should be given. Immunisation against pertussis is

not routinely recommended in individuals over 10 years of

age.

Vaccination of pregnant women against pertussis

In response to the pertussis outbreak, the UK health

departments introduced a temporary programme (October

2012) to vaccinate pregnant women against pertussis, and

this programme will continue until further notice. The aim of

the programme is to boost the levels of pertussis–specific

antibodies that are transferred through the placenta, from

the mother to the fetus, so that the newborn is protected

before routine immunisation begins at 2 months of age.

Pregnant women should be offered a single dose of

acellular pertussis-containing vaccine (as adsorbed

diphtheria [low dose], tetanus, pertussis (acellular,

component) and poliomyelitis (inactivated) vaccine;

Boostrix-IPV ®) between 16 and 32 weeks of pregnancy.

Public Health England has advised (2016) that the vaccine is

probably best offered after the fetal anomaly scan at around

18–20 weeks. Pregnant women should be offered a single

dose of acellular pertussis-containing vaccine up to the

onset of labour if they missed the opportunity for

vaccination at 16–32 weeks of pregnancy. A single dose of

acellular pertussis-containing vaccine may also be offered to

new mothers, who have never previously been vaccinated

against pertussis, until the child receives the first

vaccination.

While this programme is in place, women who become

pregnant again should be offered vaccination during each

pregnancy to maximise transplacental transfer of antibody.

Contacts

Vaccination against pertussis should be considered for close

contacts of cases with pertussis who have been offered

antibacterial prophylaxis. Unimmunised or partially

immunised contacts under 10 years of age should complete

their vaccination against pertussis. A booster dose of an

acellular pertussis-containing vaccine is recommended for

contacts aged over 10 years who have not received a

pertussis-containing vaccine in the last 5 years and who have

not received adsorbed diphtheria [low dose], tetanus, and

poliomyelitis (inactivated) vaccine in the last month.

Side-effects

Local reactions do not contra-indicate further doses.

The vaccine should not be withheld from children with a

history to a preceding dose of:

. fever, irrespective of severity;

. persistent crying or screaming for more than 3 hours;

. severe local reaction, irrespective of extent.

Useful Resources

Advice reflects that in the handbook Immunisation against

Infectious Disease (2013), which in turn reflects the guidance

of the Joint Committee on Vaccination and Immunisation

(JCVI). The advice also incorporates changes announced by

the Chief Medical Officer and Health Department Updates.

Chapters from the handbook (including updates since 2013)

are available at:

www.gov.uk/government/collections/immunisation-againstinfectious-disease-the-green-book

Pneumococcal vaccine 18-Dec-2018

Overview

The pneumococcal polysaccharide conjugate vaccine

(adsorbed) p. 1316 and the pneumococcal polysaccharide

vaccine p. 1316 protect against infection with Streptococcus

pneumoniae (pneumococcus). Both vaccines contain

polysaccharide from capsular pneumococci. The

pneumococcal polysaccharide vaccine contains purified

polysaccharide from 23 capsular types of pneumococcus,

whereas the pneumococcal polysaccharide conjugate vaccine

(adsorbed) contains polysaccharide from either 10 capsular

types (Synflorix ®) or 13 capsular types (Prevenar 13 ®). Both

vaccines are inactivated.

Prevenar 13 ® is the 13-valent pneumococcal

polysaccharide conjugate vaccine (adsorbed) used in the

childhood Immunisation schedule p. 1296. The schedule

consists of 3 doses given at separate intervals.

The 23-valent pneumococcal polysaccharide vaccine is

recommended for all adults aged 65 years and over, and for

adults and children aged 2 years and over in the following atrisk groups:

. asplenia or splenic dysfunction (including homozygous

sickle cell disease and coeliac syndrome which could lead

to splenic dysfunction);

. chronic respiratory disease (including severe asthma

treated with continuous or frequent use of a systemic

corticosteroid);

. chronic heart disease;

. chronic renal disease;

. chronic liver disease;

. diabetes mellitus requiring insulin or oral hypoglycaemic

drugs;

. immunosuppression because of disease (e.g. HIV infection,

and genetic disorders affecting the immune system) or

treatment (including prolonged systemic corticosteroid

treatment for over 1 month at dose equivalents of

prednisolone: adult and child 20 kg and over, 20 mg or more

daily; child under 20 kg, 1 mg/kg or more daily, and

chemotherapy);

. presence of cochlear implant;

. conditions where leakage of cerebrospinal fluid may occur.

The 23-valent pneumococcal polysaccharide vaccine

should also be considered for those at risk of occupational

exposure to metal fume (e.g. welders).

Where possible, the vaccine should be given at least

2 weeks (ideally 4–6 weeks) before splenectomy,

chemotherapy, or radiotherapy; patients should be given

advice about the increased risk of pneumococcal infection. If

it is not possible to vaccinate at least 2 weeks before

splenectomy, chemotherapy, or radiotherapy, the vaccine

should be given at least 2 weeks after the splenectomy, and

at least 3 months after completion of chemotherapy or

radiotherapy. For patients with leukaemia or who have had a

bone marrow transplant, refer to Chapter 25, Pneumococcal,

in Immunisation against infectious disease– ‘The Green Book’

for vaccination advice. A patient card and information leaflet

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for patients with asplenia are available from the Department

of Health or in Scotland from the Scottish Government,

Health Protection Division (Tel (0131) 244 2879).

Choice of vaccine

Vaccination regimens may differ depending on the patient’s

age, risk of pneumococcal disease, vaccination history, and

immune status. Individuals in at-risk groups may require

additional protection.

Children with unknown or incomplete vaccination histories

Unimmunised or partially immunised children who present

late for vaccination and before the age of 1 year should

receive 2 doses of the13-valent pneumococcal

polysaccharide conjugate vaccine (adsorbed) 2 months apart,

and a further dose on their first birthday, at least 2 months

after the previous dose (intervals can be reduced to 1 month

to allow the immunisation schedule to be completed

promptly).

Children aged between 1 year and under 2 years of age who

are unimmunised or partially immunised should receive a

single dose of the13-valent pneumococcal polysaccharide

conjugate vaccine (adsorbed).

Children diagnosed with at-risk conditions under 2 years of age

Children under 1 year in an at-risk group should receive the

13-valent pneumococcal polysaccharide conjugate vaccine

(adsorbed) according to the Immunisation schedule p. 1296.

Those who present late for vaccination should be immunised

according to Children with unknown or incomplete vaccination

histories above. A single dose of the 23-valent pneumococcal

polysaccharide vaccine should then be given at 2 years of

age, at least 2 months after the last dose of 13-valent

pneumococcal polysaccharide conjugate vaccine (adsorbed).

Children under 2 years who are severely

immunocompromised or those with asplenia, splenic

dysfunction, or complement disorders, should have an

additional dose of the13-valent pneumococcal

polysaccharide conjugate vaccine (adsorbed), given at least

2 months after the routine dose due on their first birthday. A

single dose of the 23-valent pneumococcal polysaccharide

vaccine should then be given at 2 years of age, at least

2 months after the last dose of 13-valent pneumococcal

polysaccharide conjugate vaccine (adsorbed).

Children diagnosed with at-risk conditions from 2 years to under

10 years of age

Children diagnosed or first presenting with an at-risk

condition aged 2 years to under 10 years of age who have

completed their routine immunisation schedule should

receive a single dose of 23-valent pneumococcal

polysaccharide vaccine, at least 2 months after the last dose

of 13-valent pneumococcal polysaccharide conjugate

vaccine (adsorbed).

Children previously unvaccinated or partially vaccinated

with the 13-valent pneumococcal polysaccharide conjugate

vaccine (adsorbed) should receive a single dose of the

13-valent pneumococcal polysaccharide conjugate vaccine

(adsorbed), followed by a single dose of the 23-valent

pneumococcal polysaccharide vaccine at least 2 months

later.

Severely immunocompromised children may have a suboptimal immunological response to the vaccine and should

be given an additional dose of the13-valent pneumococcal

polysaccharide conjugate vaccine (adsorbed), even if they are

fully vaccinated. This should be followed by a single dose of

the 23-valent pneumococcal polysaccharide vaccine, at least

2 months after the last dose of 13-valent pneumococcal

polysaccharide conjugate vaccine (adsorbed). If the

23-valent pneumococcal polysaccharide vaccine has already

been given, the 13-valent pneumococcal polysaccharide

conjugate vaccine (adsorbed) should be given at least

6 months after.

Children diagnosed with at-risk conditions aged 10 years and

over and adults

Individuals diagnosed or first presenting with an at-risk

condition should be given a single dose of the 23-valent

pneumococcal polysaccharide vaccine. No additional

23-valent pneumococcal polysaccharide vaccine is required

at 65 years of age.

Severely immunocompromised individuals should be given

a single dose of the 13-valent pneumococcal polysaccharide

conjugate vaccine (adsorbed) followed by the 23-valent

pneumococcal polysaccharide vaccine at least 2 months

after, irrespective of their previous pneumococcal

vaccinations. If the 23-valent pneumococcal polysaccharide

vaccine has already been given, the 13-valent pneumococcal

polysaccharide conjugate vaccine (adsorbed) should be given

at least 6 months after.

For further information on vaccination in patients with

asplenia, see Vaccination, general principles p. 1294.

Revaccination

In individuals with higher concentrations of antibodies to

pneumococcal polysaccharides, revaccination with the

23-valent pneumococcal polysaccharide vaccine more

commonly produces side effects (e.g. chills, asthenia, and

myalgia). Revaccination is therefore not recommended,

except for individuals in whom the antibody concentration is

likely to decline rapidly (e.g. asplenia, splenic dysfunction

and chronic renal disease), where revaccination is

recommended every 5 years.

Management of cases

For the management of cases, contacts and outbreaks, refer

to Chapter 25, Pneumococcal, in Immunisation against

infectious disease– ‘The Green Book’.

Useful Resources

Recommendations reflect Chapter 25, Pneumococcal, in

Immunisation against infectious disease– ‘The Green Book’.

Public Health England, January 2018.

www.gov.uk/government/publications/pneumococcal-the-greenbook-chapter-25

Poliomyelitis vaccine

Overview

Two types of poliomyelitis vaccines (containing strains of

poliovirus types 1, 2, and 3) are available, inactivated

poliomyelitis vaccine (for injection) and live (oral)

poliomyelitis vaccine. Inactivated poliomyelitis vaccines,

only available in combined preparation, is recommended for

routine immunisation.

A course of primary immunisation consists of 3 doses of a

combined preparation containing inactivated poliomyelitis

vaccines, starting at 2 months of age with intervals of

1 month between doses (see Immunisation schedule). A

course of 3 doses should also be given to all unimmunised

adults; no adult should remain unimmunised against

poliomyelitis.

Two booster doses of a preparation containing inactivated

poliomyelitis vaccines are recommended, the first before

school entry and the second before leaving school (see

Immunisation schedule). Further booster doses are only

necessary for adults at special risk, such as travellers to

endemic areas, or laboratory staff likely to be exposed to the

viruses, or healthcare workers in possible contact with cases;

booster doses should be given to such individuals every

10 years.

Live (oral) poliomyelitis vaccine is no longer available

for routine use; its use may be considered during large

outbreaks, but advice should be sought from Public Health

England. The live (oral) vaccine poses a very rare risk of

vaccine-associated paralytic polio because the attenuated

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