27 up-to-date information about the programme . The JCVI ’ s remit is to advise and make recommendations to the UK governments , including those in the devolved nations ; the respective governments make the final policy decisions . The programmes are then developed by the public health agencies and operationalised by the NHS in each nation .
Immunisation schedule The Green Book immunisation against infectious disease⁶ includes the latest information on vaccinepreventable diseases , vaccines and vaccination procedures for the UK programmes . The UK Health Security Agency ( UKHSA ) immunisation collection 7 includes further information and resources for the routine programme .
The UK has a lifelong vaccination programme , with the majority of vaccines offered early in childhood . The UK vaccine schedule is described in Chapter 11 of the Green Book , as well as in the individual disease chapters . The schedule is designed to ensure individuals get early protection , particularly against diseases that are very dangerous in young infants . It also includes booster doses to maintain protection as far as possible throughout life .
The timing and scheduling are based on the evidence from individual vaccine trials and real-world evidence of the efficacy and safety of previous and newly introduced vaccines . The schedule is further refined against age-specific risks of disease complications , the specific disease epidemiology in the UK , the ability of children ’ s immune system to respond to the vaccine and the risk of onward transmission . As well as a routine programme based on age , the ‘ selective immunisation schedule ’ provides protection for those at highest risk by virtue of their circumstances , such as occupation , lifestyle or underlying medical conditions
As new vaccines are introduced or amendments made , they take into consideration the wider immunisation schedule and the planned patient vaccination appointments already in the programme . The evidence shows that servicing patient appointments for vaccination within programmes can be challenging⁶ ; making sure the number of appointments required is kept to a minimum is important for programme success and to minimise health inequalities . 8
Proposed vaccine schedule changes Discontinuation of Menitorix Hib / MenC vaccine product Menitorix provides protection against H . influenzae type b ( Hib ) and invasive meningococcal group C ( MenC ) disease . Currently , Menitorix vaccine is given as part of the routine childhood immunisation schedule at 12 months of age alongside : pneumococcal conjugate vaccine ( PCV13 ), measles mumps and rubella ( MMR ) and the meningococcal B vaccine ( MenB ).
The manufacturer GSK has discontinued the product . The UK has been the only country to use this combination and the vaccine is not available elsewhere . Since 2018 , when it was first notified of the planned discontinuation , the JCVI has been discussing the options to ensure the ongoing protection against both Hib and MenC diseases . In November 2022 , the JCVI issued a final statement detailing its advice for the changes to the schedule required to provide such protection . The UKHSA has enough stock of Menitorix to last until 2025 , so there is no immediate need for this change to be implemented and the schedule will remain unchanged for the time being .
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Future protection against the H . influenzae type b disease component Vaccination against Hib started in 1992 . The schedule includes vaccination alongside other vaccines given at eight , 12 and 16 weeks of age , as well as the dose given at 12 months . The JCVI has considered the evidence 9 and a dose of this vaccine is required in the second year of life , either at 12 months or 18 months , to maintain protection .
In consideration of the vaccine products available , the JCVI is recommending that the most sustainable option would be to give this later dose alongside an additional dose of diphtheria , tetanus , polio , pertussis and hepatitis B ( DTaP / IPV / Hib / HepB ) as a hexavalent – six-in-one – vaccine – at 18 months , at an additional appointment .
Future protection against the meningococcal C disease component The vaccine programme for this disease started in 1999 , and since then there has been a significant reduction in the number of cases of meningococcal C disease . As a result , the JCVI has been able to recommend a reduction of the number of doses of MenC-containing vaccine for infants over time . MenC-containing vaccines are now given at 12 months with Hib and as a teenage quadrivalent meningococcal A , C , W and Y ( MenACWY ) vaccine . The teenage programme has proved successful in reducing the overall burden of disease and this gives indirect protection for all ages . There is also some cross-protection against meningococcal C from the meningococcal MenB vaccine ( Bexsero ). 10
Given this additional indirect protection and the overall falling incidence of meningococcal infection , 11 the JCVI is advising that an additional dose of MenC vaccine for infants or toddlers should no longer be necessary . It is vital , however , that high uptake in the teenage programme is maintained .
Considerations for the timing of an additional vaccination Various options for the timing of an additional Hib-containing vaccine , as a hexavalent vaccine , have been discussed by the JCVI .
• An additional multivalent vaccine gives the opportunity to boost protection against other infectious diseases such as polio , diphtheria and pertussis . The timing of this for polio would be vital but offering this slightly later at 18 months would give better longer-term protection for pertussis .
• There are already a number of other vaccines given at 12 months : pneumococcal conjugate ( PCV ), meningococcal 4CMenB and MMR . Giving the additional hexavalent vaccine at 18 months would reduce the number of vaccines needed at the 12-month visit .
• Giving the dose at 18 months and introducing an additional visit leaves potential space in the programme and scope for other programme changes , such as the potential to bring forward the second dose of MMR .
Considerations for measles and MMR High uptake of MMR is essential to control measles . Two doses of MMR vaccine are required for maximum immune protection and are currently routinely offered at 12 months and then at three years and four months . Unfortunately , uptake has been gradually decreasing over the past 10 years . In recent years , rates of infection have been kept low because of social distancing measures introduced to reduce transmission of the Covid-19 virus , but during 2022 there has been a number of reported cases in unvaccinated individuals . Ongoing surveillance is maintained . 12