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Immunisation, childhood

Vaccination

The vaccines

Routine vaccinations:

These are the routine vaccinations that are offered free of charge on the NHS to all babies and children in the UK.

A change to the childhood vaccination schedule means that from November 2010 rather than one visit at 12 months of age to give Hib/MenC and a second visit at 13 months of age to give PCV and MMR, the boosters of Hib/MenC and PCV are now offered with MMR in a single visit between 12 and 13 months of age (that is, within a month after the child's first birthday).

DTaP/IPV/Hib or 5-in-1 vaccine
Protects against: diphtheria, tetanus, pertussis (whooping cough), polio and Hib (haemophilus influenza type B).
Given at: 2, 3 and 4 months of age.
More about the 5-in-1 vaccine

Pneumococcal (PCV)
Protects against: some types of pneumococcal infection.
Given at: 2, 4 and 12-13 months of age.
More about the pneumococcal jab

Meningitis C (MenC)
Protects against: meningitis C (meningococcal type C).
Given at: 3 and 4 months of age.
More about the MenC jab

Hib/MenC (booster)
Protects against: haemophilus influenza type b (Hib) and meningitis C.
Given at: 12-13 months of age.
More about the Hib/MenC booster

MMR
Protects against: measles, mumps and rubella.
Given at: 12-13 months and at 3 years and 4 months of age, or sometime thereafter. 
More about the MMR jab NHS Direct Wales

DTaP/IPV (or dTaP/IPV) ‘pre-school’ booster
Protects against: diphtheria, tetanus, pertussis (whooping cough) and polio.
Given at: 3 years and 4 months of age or shortly thereafter.
More about the DTaP/IPV pre-school booster

Non-routine vaccinations:

These vaccinations are offered, in addition to the routine programme, to special ‘at risk’ groups of babies and children.

Chickenpox vaccination is generally only offered to siblings of children who have suppressed immune systems and are susceptible to chickenpox, for example, because they're having cancer treatment or have had an organ transplant.

BCG vaccination is offered to babies and children who have a high chance of coming into contact with tuberculosis.

Vaccination against seasonal flu (and swine flu) is recommended for children with certain medical conditions or a weakened immune system, which may put them at risk of complications from the infections.

Varicella
Protects against: chickenpox.
Given: from one year of age upwards (one dose for children from one year to 12 years. Two doses given 4-8 weeks apart for children aged 13 years or older).
More about the varicella jab
 
BCG (Bacillus Calmette-Guerrin)
Protects against: tuberculosis (TB).
Given: from birth to 12 months of age.
More about the BCG vaccine Welsh Government

Flu
Protects against: seasonal flu.
Given: from six months and over in a single jab every year in October/November.
More about the flu jab NHS Direct Wales

Swine flu
Protects against: swine flu.
Who needs it: children with long-term health conditions or weakened immune system.
Given: as part of the swine flu programme in 2009/10.
More on the swine flu vaccine Welsh Government 2010-11

Hepatitis B
Protects against: hepatitis B.
Who needs it: children at high risk of exposure to hepatitis B, and babies born to infected mothers.
Given: at any age, as four doses given over 12 months. A baby born to a mother infected with hepatitis B will be offered a dose at birth, one month of age, 2 months of age and one year of age.
More on the hepatitis B vaccine Welsh Government

Vaccines for teens

The teenage years are a key time for some important vaccinations.

The human papillomavirus (HPV) vaccination, also known as cervical cancer vaccination, is offered routinely to all 12- to 13-year-old girls to protect them from cervical cancer in later life. The jab protects against two types of HPV, which cause more than 70 per cent of cervical cancers.

Students, too, may need certain vaccinations. Infections can spread among students very quickly, and there have been serious outbreaks of mumps in universities in recent years. Teenagers leaving home to go to college or university should be vaccinated against mumps and meningitis C if they didn't have those vaccinations as children.

The vaccines

These vaccinations are routinely available on the NHS for teenagers:

Teenage booster (Td/IPV)
Protects against: tetanus, diphtheria and polio.
Given at: between ages 13 and 18.
More on the Td/polio booster

Cervical cancer vaccination (HPV, or human papillomavirus vaccination)
Protects against: human papillomavirus, which has been shown to cause cervical cancer in women.
Given at: 12-13 (girls only) and also, for the time being, to girls aged between 13 and 18 as part of a catch-up programme. 

Some teenagers are also advised to have the following non-routine vaccinations on the NHS if they're in an 'at risk' group.

Meningitis (MenC) vaccine
Protects against: meningitis C (meningococcal group C).
Who needs it: teenagers, especially those leaving home to go to college or university, should be vaccinated against meningitis C if they didn't have this vaccination as a child.
Given: before going to university, or as soon as possible after starting.
More on the MenC jab

MMR vaccine
Protects against: measles, mumps andrubella (German measles).
Who needs it: teenagers leaving home to go to college or university should be vaccinated with MMR if they missed out on this vaccination or didn’t complete the full course (two doses of MMR) as a child.
Given: before going to university or as soon as possible after starting.
More on the MMR jab

Flu vaccine
Protects against: seasonal flu.
Who needs it: teenagers should have an annual flu vaccination if they're in one of the 'at-risk' categories. For example, if they have diabetes, or asthma that requires inhaled steroids, or a serious long-term condition, such as kidney, liver or heart disease. Also, teenagers who take medication that affects their immune system, such as steroid tablets.
Given: every year starting from October/November.
More on the flu jab Welsh Government

Hepatitis B vaccine
Protects against: hepatitis B.
Who needs it: teenagers who are injecting drug users, using crack cocaine, smoking heroin or likely to progress to injecting drug use; those living with injecting drug users; the sexual partners of injecting drug users; teenagers who change sexual partner frequently; teenagers travelling for extended periods to places where the disease is more common, for instance southern and Eastern Europe, Africa and Asia. Also, teenagers with certain long-term kidney or liver conditions, or those receiving blood products. 

Given: before going to university or as soon as possible after starting (three doses of vaccine are given initially over a short period, then a fourth dose after 12 months).
More on the hepatitis B jab 

Mumps alert
There has been a lot of mumps among teenagers in recent years. Advice on how to prevent the disease with vaccination.
More on the mumps alert

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When should it be done?

Vaccination checklist

There's a recommended timetable for routine childhood vaccinations. This timetable has been worked out to give children the best chance of developing immunity against common diseases safely and effectively, and doing it early enough to minimise their risk of catching these diseases.

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.

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. See vaccines for adults to find out whether you should have one.

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 travel vaccines to find out more about whether you should have one.

If you’re not sure whether you or your child have had all your vaccinations, ask your GP or practice nurse.

When to start childhood vaccinations:

Routine childhood vaccinations start when a baby is two months old. This may seem very young, but babies can catch diseases at any time, so the earlier we start the better. It’s a good age to start vaccinations because the natural immunity to illness that newborn babies get from their mother begins to wear off (if a vaccine is given before 2 months of age, the baby’s natural immunity to disease may stop the vaccine from working).

That's why parents should ideally try to have their child vaccinated at the recommended time. Any delay can leave your baby unprotected against illnesses that are often more common and worse in younger children.

Premature babies:

Babies who are born early can be at greater risk from infections than babies born on time. This is because their immune systems are less developed. Also, they don’t receive as much natural immunity from their mothers.

It’s especially important that premature babies get their vaccines on time, from two months after birth, no matter how premature they are.

It may seem very early to give a vaccination to such a tiny baby, but many scientific studies have shown that it’s a good time to give them vaccines. Postponing vaccination until they're older leaves them vulnerable to diseases.

If your baby was born very prematurely (less than 26 weeks of pregnancy), they may still be in hospital when they're recommended to have their first vaccinations. In this case, your baby will receive their first jabs in hospital.

Booster jabs:

Some vaccines are given more than once. The gap between these different doses of vaccines is to make sure that each dose has time to work effectively.

However, the recommended gap is only a minimum. If the gap is longer, for example, because you missed an appointment, you don’t have to start the course again.

Vaccination for life:

The UK childhood vaccination schedule tells you when each routine vaccination should be given. The schedule of vaccinations starts when your baby is two months old. It's normally completed by the time they're 18. Other non-routine vaccines may be needed throughout childhood, for example, for travel or for children with certain medical conditions.

Have a look at the schedule to make sure that your child is fully protected.

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Why is it necessary?

Reasons to have your child vaccinated   

As a parent, you may not like seeing your baby or child being given an injection. However, vaccination is an important step in protecting your child against a range of serious and potentially fatal diseases.

Vaccinations are quick, safe and extremely effective. Once your child has been vaccinated against a disease, their body can fight that disease more effectively if they come into contact with it. 

If a child isn’t vaccinated, they will be at increased risk of catching the illness.

There will always be some children who are unavoidably unprotected because:

  • they can't be vaccinated for medical reasons
  • they're too young to be vaccinated
  • they can't get to the vaccine services
  • for a few, the vaccine doesn’t work

But if more parents have their children vaccinated, then more children in the community will be protected against catching an illness. This lowers the chance of an outbreak of the disease.

The only time that it’s safe to stop vaccinating children against an illness is when the disease has been wiped out worldwide.

For example, when every country had eliminated smallpox in 1979, vaccination against the disease was stopped. It’s hoped that polio will soon be eradicated, and that measles may follow.

 

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Side effects

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.

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.

A note for parents:

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.

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Appointments

Appointments checklist

When your baby or child is due for a routine vaccination, you may receive a notice of the appointment in the post.

Before the appointment:

  • inform the surgery who will be taking the child, if neither a parent nor guardian can attend
  • check the appointment notice to see whether the appointment is at your GP surgery or local child health clinic
  • take your red book to the appointment

At the appointment:

  • report to reception so that they know you're there

The nurse or doctor will check:

  • your child's general health, and what medicines they may be taking
  • which vaccines your child is going to have
  • that you know what diseases they’ll protect against
  • that you know what side effects may occur, and how to treat them
  • that you’re happy to go ahead

After the injection:

  • make sure that the type of injection (and where it was given) is noted down in your red book and in your child’s GP records. Your child may need this information later in life, for example when applying for certain jobs or going abroad to live or study

If you miss an appointment:

Don’t panic. You don’t have to start the course of vaccines again. Just make a new appointment as soon as you can.

For more information on how to prepare your child for a vaccination, see our key tips for parents below.

Six practical tips for parents

Fussy clothing, fear and being in a hurry are the main problems to avoid when taking your child for a jab. With common sense and forward planning, getting vaccinated needn’t be a trauma for you or your child.

Some parents mistakenly think that having a vaccination is similar to having a blood test. The good news is that vaccination is much quicker, simpler and less painful.

Clothing:

Wearing the right clothes can save you time and effort at the surgery.

If you want your child to have a trouble-free vaccination, avoid chunky, padded or tight-fitting clothes with lots of buttons and straps. They take time to remove and put back on.

Choose clothes that you can remove or roll up easily. Babies under 12 months have jabs in the thigh. Older children have them in the arm. Thin cotton layers fastened with poppers are perfect for babies, and loose or short sleeves are ideal for older children.

Timing:

Give yourself enough time to get to your appointment without having to rush. Don’t put pressure on yourself to be in and out of the surgery quickly.

Ideally, allow yourself an hour. Clinics can run behind schedule, and you need time to ask the nurse questions. If you rush, you’ll be stressed. Your child will sense that and become anxious.

Anxiety:

It’s natural to get anxious when your baby or child is having a vaccination. You may worry that the doctor or nurse will hurt them. But try to stay calm and treat the procedure in a matter-of-fact way. If you're anxious, this fear may spread to your child. The less fuss, the better.

Usually, the nurse will ask you to hold your child on your knee. If the injection is given swiftly, your child won’t even see the needle or notice that anything has happened. If you’re nervous about seeing your child having an injection, ask a nurse or another member of staff to hold them for you.

Older children generally find it less traumatic if parents explain that vaccination is a good thing that'll keep them healthy. Use plain language to prepare your child for what's going to happen at the surgery.

Pain and fever:

Vaccinations shouldn’t hurt, although the area injected can be sore and red afterwards. Your child may develop a mild fever (a temperature greater than 37.5ºC) after the vaccination. If a fever develops, you can give your child infant paracetamol or ibuprofen to treat it.

Allergic reactions:

A serious allergic reaction (anaphylaxis) to a vaccination is rare. If it does happen, it's rapid and usually happens within minutes. The people who give vaccinations are trained to deal with anaphylactic reactions. Children recover completely with treatment.

Tell the nurse before the injection about any bad reactions your child has had following any previous vaccinations.

Children rarely faint after a vaccination. But if your child is prone to fainting, ask if they can have the vaccination lying down.

Relatives:

If a relative is taking your child for their vaccinations, they must have a letter from you. Relatives or friends need permission from the person who has parental responsibility (this includes fathers who don't have parental responsibility). An easy way to give permission is by writing a letter, although the arrangement doesn't have to be made in writing.

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Myths and truths

Myths and truths about vaccinations

Should your toddler have an MMR jab if they have severe eczema? There are many myths and misunderstandings about whether it’s safe to have a vaccine. Here are the facts about when your child should and shouldn't have jabs.

FACTS:

It's a FACT that you should postpone your child's jab if:

  • your child is ill and has a fever (high temperature). This is to avoid the fever being linked with the vaccination, or the vaccination making your child's fever worse
  • your child has had a bad reaction to a previous dose of the vaccine. It doesn’t rule out having a further dose, but it’s a good idea to speak to your GP, practice nurse or health visitor. Your child shouldn't have a vaccine if they've had a confirmed anaphylactic reaction (a severe allergic reaction) to a previous dose of the vaccine or a component of it

Your child shouldn't have BCG (tuberculosis vaccination) or MMR, which are all ‘live’ vaccines, if:

  • your child is taking high-dose steroid tablets, or is taking lower doses either alongside other drugs or over a long time. If you’re not sure, check with your GP
  • your child is being treated for cancer with chemotherapy or radiotherapy, or has had these treatments within the last six months
  • your child has had an organ transplant and is on immunosuppressant drugs.
  • your child has had a bone marrow transplant and finished all immunosuppressive therapy within the last 12 months
  • your child's immune system is lowered. If you’re not sure, check with your GP

MYTHs

It is a MYTH that you have to avoid or delay your child's vaccination if he or she:

  • has a minor infection without a fever, such as a cough or cold
  • has a family history of bad reactions to vaccinations
  • has already had diseases such as whooping cough, measles, rubella (German measles) or mumps
  • was born prematurely
  • has a stable neurological condition, such as cerebral palsy
  • has been in contact with an infectious disease
  • has a condition such as asthma, hay fever, eczema or ‘snuffles’
  • is taking antibiotics or locally acting steroids (such as creams or inhalers)
  • is being breastfed
  • lives with someone who's pregnant (including the child's mother)
  • had jaundice after birth
  • is underweight
  • is above the recommended age for vaccination
  • has a history of allergy
  • has a history of febrile convulsions (convulsions related to fever) or epilepsy, or there's a family history of such conditions
  • is a close contact or sibling of an immunosuppressed person
  • has a personal or family history of inflammatory bowel disease, such as Crohn's disease or ulcerative colitis
  • has a personal or family history of autism and related disorders
  • has recently had an operation, or is due to have one soon

Homeopathy

It's a dangerous MYTH that homeopathy can be used as an alternative to vaccinations to protect children against potentially serious infections. In fact, there's no evidence that homeopathy can protect children against disease.

Swimming

It's a MYTH that it is unsafe to take your baby swimming around the time of a vaccination. In fact, you can take your baby swimming at any time before and after their vaccinations.

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Q&A

Common questions: Vaccinations 

Why aren't separate measles, mumps and rubella vaccines available on the NHS?

MMR contains three separate vaccines in one injection, and protects children against measles, mumps and rubella (german measles).

Babies are immune to measles, mumps, and rubella during the first 12 months of life, so children are given the MMR vaccination at 13 months of age, followed by a booster injection before they start school.

Independent expert groups around the world, including the World Health Organisation and the Department of Health, agree that the MMR vaccination is preferable to having three separate injections.

There is no evidence to suggest that separate vaccines are safer than the MMR vaccination, and having single vaccines could put your child at risk of catching the diseases in the gaps between vaccines. The MMR vaccination gives children the best protection against catching measles, mumps, and rubella which are serious, and potentially fatal, diseases.

As the MMR vaccination is the safest, most effective way of protecting children against measles, mumps, and rubella, the NHS does not offer separate vaccines.

Separate measles and mumps vaccines, offered by some private clinics, are unlicensed for use in the UK. The vaccine licensing process ensures that there is evidence from properly conducted scientific studies to demonstrate that vaccines work safely.

Publicity in 1998 highlighted a report claiming a link between the MMR jab and autism and/or inflammatory bowel disease (IBD). However, numerous studies investigating this claim found no link between the MMR vaccine and these conditions.

Why aren't children in the UK vaccinated against chickenpox?

The chickenpox vaccine is not part of the UK childhood vaccination programme, because experts think that introducing a chickenpox vaccination for children could increase the risk of shingles in older people. It is used to protect people who are most at risk of a serious chickenpox infection.

Chickenpox is usually a mild illness, particularly in children. The condition is so common in childhood that 90% of adults who grow up in the UK are immune to the chickenpox virus because they have had it before.

Chickenpox vaccine

The chickenpox vaccine can be used to immunise people who may pass the infection on to someone who is at risk. For example:

  • healthcare workers who are not immune to chickenpox
  • people in close contact with someone who has a weakened immune system

Are the additives in vaccines harmful?

A vaccine is made up of several different substances and components. Most vaccines need to include additives, to help improve their effectiveness and to increase their shelf life. The three primary substances which are added to vaccines include:

  • Adjuvant - this substance helps make the vaccine more effective. It works by stimulating the body's immune system to fight off bacteria and infection more quickly. It means that less of the vaccine has to be administered in order for it to be effective.
  • Stabiliser - this additive helps to ensure that the vaccine still works even when it is exposed to changes in environment, such as light and temperature. This means that the vaccine will be able to be stored for longer periods of time.
  • Preservative - this substance helps prevent foreign bacteria, or fungi, from contaminating the vaccine. If the vaccine were to become contaminated, it could cause the person taking it to develop a serious infection.

All three of these additives play a very important role in vaccines. The additives in vaccines will pose no risk to your, or your child's, health. The additives tend to improve the safety of a vaccine rather than compromise it. Vaccines always undergo years of development and testing to ensure that they are safe to use.

Some vaccinations may include stabilizers which contain traces of egg protein and gelatine. For example, the measles vaccine contains traces of egg. In very rare cases, this may provoke an allergic reaction. However, the reaction will usually be very mild, and rarely requires treatment. If you are concerned that you, or your child, may be affected by an allergy when taking a vaccine, speak to your GP for further advice.

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