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Immunisation, adult

Vaccination

Vaccines for adults

There are no vaccinations that are routinely offered on the NHS to all adults. However,  there are several vaccinations that are available on the NHS to adults in certain ‘at risk’ groups. These are:

Seasonal flu vaccine
Protects against: seasonal flu.
Who needs it:

  • all people aged 65 years and over
  • all those with a long-term health condition 
  • healthcare workers
  • all pregnant women who haven't already had the swine flu vaccine

Given: every year starting in October/November.
More on the flu jab

Pneumococcal vaccine (PPV)
Protects against: some types of pneumococcal infection.
Who needs it:

  • people aged 65 and over
  • people with a long-term health condition

Given at: any time (one injection)
More on the pneumococcal jab

Whooping cough (pertussis) vaccine
Protects against: whooping cough

Who needs it:

  • pregnant women

Given at: between 28 and 38 weeks of pregnancy as a single injection.

More on the whooping cough for pregnant women

Chickenpox (varicella) vaccine
Protects against: chickenpox.
Who needs it:

  • healthcare workers who aren't immune
  • laboratory staff who could be exposed to varicella
  • healthy susceptible contacts of immunocompromised patients

Given at: any age (two doses given 4 to 8 weeks apart).
More on the varicella vaccine

Hepatitis B (hep B) vaccine
Protects against: hepatitis B.
Who needs it:

  • injecting drug users (including their partners and children and other people living with them)
  • people who change sexual partners frequently (including men who have sex with men, and male and female sex workers)
  • close family contacts of someone with a chronic hepatitis B infection
  • individuals receiving regular blood products, and their carers
  • people who have chronic kidney failure
  • people who have chronic liver disease
  • inmates of custodial institutions and some prison service staff
  • people who live in residential accommodation for those with learning difficulties
  • families that foster or adopt children who may have been at increased risk of hepatitis B infection 
  • people travelling to, or going to live in, areas where there's a high or intermediate incidence of hepatitis B
  • individuals at occupational risk, such as healthcare workers, laboratory staff and staff of residential and other accommodation for those with learning difficulties, morticians and embalmers, and some emergency services personnel

Given at: any age where needed.
More on the hep B vaccine

Tuberculosis (BCG) vaccine
Protects against: tuberculosis (TB).
Who needs it:

  • people at occupational risk, such as healthcare workers, some laboratory staff, people who handle animal species that are susceptible to TB, some prison staff, those working in homes for older people, staff of hostels for homeless people and facilities for refugees and asylum seekers
  • previously unvaccinated tuberculin-negative contacts of cases of respiratory TB

Given at: any age.
More about the BCG jab

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When should it be done?

Vaccination checklist

Here's a checklist of the vaccines that are routinely offered to everyone in the UK for free on the NHS, and the age at which you should ideally have them.  If you’re not sure whether you or your child have had all your vaccinations, ask your GP or practice nurse.

2 months:

  • Diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib, a bacterial infection that can cause severe pneumonia or meningitis in young children) given as a 5-in-1 single jab known as DTaP/IPV/Hib
  • Pneumococcal infection 

3 months:                    

  • 5-in-1, second dose (DTaP/IPV/Hib)
  • Meningitis C

4 months:

  • 5-in-1, third dose (DTaP/IPV/Hib)
  • Pneumococcal infection, second dose
  • Meningitis C, second dose

Between 12 and 13 months:

  • Meningitis C, third dose
  • Hib, fourth dose (Hib/MenC given as a single jab)
  • MMR (measles, mumps and rubella), given as a single jab
  • Pneumococcal infection, third dose

3 years and 4 months, or soon after:

  • MMR second jab
  • Diphtheria, tetanus, pertussis and polio (DtaP/IPV), given as a 4-in-1 pre-school booster

Around 12-13 years:

  • Cervical cancer (HPV) vaccine, which protects against cervical cancer (girls only): three jabs given within six months

Around 13-18 years:

  • Diphtheria, tetanus and polio booster (Td/IPV), given as a single jab

65 and over:

  • Flu (every year)
  • Pneumococcal

Vaccines for risk groups

People who fall into certain risk groups may be offered extra vaccines. These include vaccinations against diseases such as hepatitis B, tuberculosis (TB), seasonal flu and chickenpox.

Pregnancy

Currently the Whooping cough (pertussis) vaccine is offered to all pregnant women.  The vaccine is given between 28 and 38 weeks of pregnancy as a single injection.

The flu vaccine is also offered to all pregnant women at any stage of pregnancy. 

Travel and other vaccines

There are also optional vaccines that you may be able to have free on the NHS from your local surgery, including travel vaccinations, such as hepatitis A, typhoid and cholera. See our sections on travel vaccines to find out more about whether you should have one.

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Advantages and Disadvantages

Weighing up the risks

All medicines have side effects, but vaccines are among the safest. The benefits of vaccinations far outweigh the risk of side effects.

When we’re considering a vaccination for ourselves or our children, it's natural to think about the potential side effects of that vaccination. But you have to balance the risk against the benefits.

So, what are the side effects of vaccination?

Most side effects from vaccination are mild. It's quite usual for people to have redness or swelling in the place where they had the injection, but this soon goes away. Younger children or babies may be a bit irritable or unwell or have a slight temperature. Again, this goes away within one or two days.

Find out how to report a side effect to a vaccination.

In much rarer cases, some people have an allergic reaction soon after a vaccination. This is usually a rash or itching that affects part or all of the body. The GP or nurse giving the vaccine are trained to treat this.

On very rare occasions, a severe allergic reaction may happen within a few minutes of the vaccination. This is called an anaphylactic reaction. It can lead to breathing difficulties and, in some cases, collapse.

Remember that anaphylactic reactions are extremely rare (less than one in a million). Vaccination staff are trained to deal with these reactions, and they're completely reversible if treated promptly.

Vaccination versus medicine 

Vaccination is different from giving medicine to an unwell child to make them better. The benefits of vaccination are invisible. Your child won't become ill with measles or crippled by polio, or end up in intensive care with meningitis C.

It may be tempting to say 'no' to vaccination and 'leave it to nature' instead. However, deciding not to vaccinate your child puts them at risk of catching a range of potentially serious, even fatal, diseases.

In reality, having a vaccination is much safer than not having one. They’re not 100% effective in every child, but they’re the best defence against epidemics that used to kill or permanently disable millions of children and adults.

Read more about the safety of vaccinations.

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Safety and regulation

Vaccination safety

As with all new medicines, all vaccines are extensively tested for safety before they're made routinely available to the general public.

Safety monitoring continues even after a vaccine has been made available. That's because not all side effects are always noticed during the vaccine's development, especially if they're very rare side effects. All vaccines in general use are continually and carefully monitored to identify such side effects.

The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for checking the safety of medicines (including vaccines) that have been made available to the public.

The MHRA collects important information on vaccine safety via the Yellow Card Scheme, whereby anyone can report a suspected side effect to the MHRA.  For more information on how to use it, go to our page how to report a vaccine side effect.

As well as the Yellow Card Scheme, the MHRA uses a variety of other sources of safety information, including medical literature, safety studies done by vaccine makers, databases that track trends in illnesses, and other worldwide organisations. 

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Why should it be done?

Vaccinations save lives

Because of vaccination, we no longer see smallpox, and polio is heading towards eradication. No wonder vaccination is considered a modern miracle.

Vaccination is one of the greatest breakthroughs in modern medicine. No other medical intervention has done more to save lives and improve quality of life.

Smallpox ravaged and killed thousands of people in Europe in the 18th century. Once caught, the disease would kill around a third of victims and leave survivors scarred or blinded.

Smallpox was officially declared wiped out in 1980. If it were still common around the world, it would cause an estimated two million deaths every year.

Polio

By 2002, the incurable and deadly disease of polio had also been eradicated from much of the world, including the UK, the rest of Europe, the western Pacific and the Americas.

Polio, caused by a virus that destroys nerve cells, used to threaten millions of people worldwide. At its peak, more than 1,000 children a day across the world were paralysed by polio.

The disease paralysed up to one in 1,000 children and one in 75 adults who caught the infection – not only in their arms or legs but also their breathing muscles, which put them at risk of suffocation.

Then, the only way to keep children with polio-induced respiratory problems alive was to put them in a giant metal machine, an ‘iron lung’, to help them breathe. Hospital wards with children in iron lungs were common as recently as 50 years ago.

Read more about polio.

Whooping cough and diphtheria

Thanks to the NHS and its childhood vaccination programme, children in the UK are now protected against many dangerous diseases. As well as polio, this includes many other potentially deadly infections, such as diphtheria and whooping cough (pertussis).

In 1940 there were more than 60,000 cases and 3,283 deaths from diphtheria in the UK. Before the 1950s, there were an average of 120,000 cases of whooping cough each year in the UK.

By 2008, vaccination of children had almost eliminated diphtheria (there were just six cases in the UK that year – all imported), and dramatically reduced whooping cough to 1,028 cases.

Although the number of cases of whooping cough has fallen dramatically since vaccination began, it is still possible for children to get the infection, so having the vaccination is vital.

There were 1,080 cases in the first quarter of 2012 in England and Wales. While there were only 910 cases during the whole of 2011.

Meningitis C

Meningitis C has been virtually eliminated since vaccination was introduced in the UK in 1999 (the first country in the world to offer the jab). There has been a 99% reduction in cases of meningitis C among under-20s since vaccination started.

In 1998, the year before the vaccine was introduced, there were 78 deaths among children and teens. There were no deaths in these groups in 2007 and 2008.

Read more about meningitis C.

Why we still need vaccines

All these diseases are now so rare that it’s easy to underestimate the importance of children’s vaccinations.

But whooping cough and diphtheria are still a threat. The diseases may be rare now, but if children aren’t vaccinated, they can return with a vengeance.

After a scare about the safety of the whooping cough vaccine in the 1970s and 80s, parents stopped vaccinating their children against the disease. This led to three epidemics, and at least 100 children died after catching the disease.

When Russia’s childhood vaccination programme collapsed during the break-up of the Soviet Union, it triggered a mass epidemic of diphtheria.

The history of vaccination, post 1880s:

  • 1880s: A vaccine against rabies
  • 1920s: Vaccines become widely available - by the end of the 1920s, vaccines for diphtheria, tetanus, whooping cough and tuberculosis (TB) were all available.
  • 1955: Polio vaccination begins in the UK
  • 1956: WHO fights to eradicate smallpox - first attempt to use smallpox vaccine on a global scale began
  • 1980: Smallpox eradicated from the world
  • 2008: Cervical cancer scientist awarded Nobel Prize - led to the development of the HPV vaccine which protects against cervical cancer, and which is now widely available.
  • 2008: NHS vaccinates girls against cancer

The future of vaccination

There will be many more potentially life-saving vaccines in the years to come. Research is thriving, with more than 150 new vaccines currently being tested.

Soon we will have an improved pneumococcal vaccine that offers protection against more strains of the disease.

There's also a vaccine against a leading cause of diarrhoea called rotavirus, and promising work on longer-lasting vaccines against flu.

There’s hope for a vaccine against meningitis B – the most feared type of meningitis. It affects around 1,200 people (mostly children) in the UK each year, and kills around 80 annually. 

Now, find out which vaccinations you and your family are eligible for on the NHS by using our vaccination checklist.

Vaccination facts from around the world

  • Three million children die every year from diseases that are entirely preventable.
  • 30 million babies aren't able to get basic vaccinations each year.
  • In almost 50 countries, nearly two-thirds (60%) of children are not vaccinated.
  • A child in the developing world is 10 times more likely to die of a vaccine-preventable death than a child in an industrialised nation.

Protecting children

The GAVI Alliance (formerly The Global Alliance for Vaccines and Immunisation) was formed in 1999 to ensure that every child in the world is protected against vaccine-preventable diseases. It also funds research into other child-killing diseases, such as AIDS, tuberculosis and malaria.

GAVI members include governments, the Bill & Melinda Gates Foundation, UNICEF, the WHO, the vaccine industry represented by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), The Rockefeller Foundation, The World Bank Group, and research and public health institutions.

The good news about vaccination

Already the GAVI Alliance is paying off. Thirty years ago, one in four children died before the age of five. Today, that number is one in 10. Close to 75% of the world’s children are now vaccinated against the six main killer diseases (measles, polio, diphtheria, whooping cough, tuberculosis and tetanus). The number of deaths from these diseases has been more than halved since 1980.

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How does it work?

Vaccines work by stimulating our immune system to produce antibodies (substances produced by the body to fight disease) without us actually becoming infected with the disease.

Vaccines trigger the immune system to produce its own antibodies against disease, as though the body has been infected with it. This is called 'active immunity'. If the vaccinated person then comes into contact with the disease itself, their immune system will recognise it and immediately produce the antibodies needed to fight it.

Newborn babies are already protected against several diseases, such as measles, mumps and rubella, because antibodies have passed into them from their mothers via the placenta. This is called ‘passive immunity’.

Passive immunity only lasts for a few weeks or months. In the case of measles, mumps and rubella, it may last up to one year (which is why the MMR jab is given to children just after their first birthday).

How are vaccines made?

The first step is to make the organism (called the pathogen) that produces the disease. The pathogen is a virus or a bacterium. Viruses and bacteria can be mass produced in the laboratory by infecting cells grown in tissue culture.

The pathogen must then be altered to ensure that it doesn’t trigger the disease itself. This can be done by:

  •  weakening, or ‘attenuating’ it by growing it repeatedly to select a strain that's less dangerous. MMR vaccines are attenuated
  •  taking out the part of the pathogen that causes the immune response and using this in the vaccine. The Hib vaccine is made in this way
  •  using the toxin that the pathogen makes and inactivating it. The tetanus vaccine is produced in this way

The treated pathogen is then combined with other ingredients, such as stabilisers and preservatives, to produce a dose of vaccine. 

How long does a vaccination last?

In many cases vaccination provides lifelong protection against a disease but it varies. How long a vaccination lasts will depend on the disease that the vaccine protects against, the vaccine, and the person who is vaccinated.

Some vaccines provide very high levels of protection - for example MMR provides 90% protection against measles and rubella after one dose. Others are not as effective – for example typhoid vaccine (a travel vaccine) provides about 70% protection over three years.

How a vaccination programme works

When a vaccination programme is introduced, everyone in the population of a certain age or risk group is offered a specific vaccine to try and reduce disease.

Vaccination programmes aim to protect people for life. They often concentrate on young children, as they’re especially susceptible to many potentially dangerous infections. Some vaccination programmes are targeted at older people or certain risk groups.  

When a vaccination programme against a disease begins, the number of people catching the disease goes down. But as the threat recedes it’s important to keep vaccinating, otherwise the disease can start to spread again.

If enough people in a community are vaccinated, it’s harder for a disease to pass between those who are not. This is called herd immunity.

Herd immunity is particularly important in protecting people who can't get vaccinated because they're too ill or they're having treatment that damages their immune system.

The Department of Health and an organisation called the Health Protection Agency (HPA) record the vaccinations that adults and children receive. The HPA also records the number of cases of each disease each year. This way, the HPA can work out the impact that each vaccination has on a particular disease. This data helps the Joint Committee on Vaccination and Immunisation (JCVI) consider whether the routine vaccination programme needs to be changed.

Eliminating disease

As more and more of the population is vaccinated, the disease can sometimes disappear completely and the vaccination programme can be stopped – as has happened with smallpox.

The more infectious the disease, the greater the number of people who have to be vaccinated to keep the disease under control.

Measles, for instance, is highly infectious. If vaccination rates go down, measles will quickly spread again.

We know that at least 90% of children have to be immune in order to stop the disease from spreading. If 95% of children are protected by MMR, it’s possible to eliminate not just measles, but mumps and rubella as well.

Now, read how vaccines are fighting disease around the world.

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Side effects

What to do about side effects

If you, a doctor, nurse or pharmacist suspects that you or your child has had a possible side effect (also called an adverse reaction) to a vaccine, then it can be reported through the Yellow Card Scheme.

The Yellow Card Scheme is run by the Medicines and Healthcare products Regulatory Agency (MHRA) and is designed to pick up unexpected problems or new side effects. If a serious new side effect is identified, the MHRA will follow up the report. It may change the way a vaccine is used, or even take it off the market.

The scheme isn’t just for health professionals. The general public can also use the Yellow Card system to report a suspected side effect of a vaccine or medicine.

It's often hard to tell whether a possible side effect is due to a vaccine or something else. If you're in any doubt, it’s a good idea to alert the MHRA by sending a Yellow Card report.

Tell your doctor, nurse or pharmacist about the suspected side effect, and they'll report it for you. Or report it yourself in one of these ways:

  • Use the Yellow Card Scheme online reporting system.
  • Pick up a Yellow Card form from your GP surgery or your local pharmacy. Complete the form and send it to the address given on the form.
  • Call the Yellow Card freephone hotline on 0808 100 3352 (weekdays 10am to 2pm).

Read more about the safety of vaccinations.

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