vaccination of individuals with uncertain (unknown) or incomplete immunisation status

Last edited 03/2022 and last reviewed 03/2022

Vaccination of individuals with uncertain or incomplete immunisation status

General principles

• unless there is a documented or reliable verbal vaccine history, individuals should be assumed to be unimmunised and a full course of immunisations planned
• individuals coming to the UK part way through their immunisation schedule should be transferred onto the UK schedule and immunised as appropriate for age
• if the primary course has been started but not completed, resume the course - no need to repeat doses or restart course
• plan catch-up immunisation schedule with minimum number of visits and within a minimum possible timescale - aim to protect the individual in the shortest time possible

Infants from two months of age up to first birthday

• DTaP/IPV/Hib/HepBa + MenBb + rotavirusc
• Four week gap
  • DTaP/IPV/Hib/HepB + PCVd + rotavirusc
• Four week gap
  • DTaP/IPV/Hib/HepB + MenBb
• a A child who has already received 1 or more doses of primary diphtheria, tetanus, polio and pertussis should complete the 3 dose course with DTaP/IPV/
  Hib/HepB. Any missing doses of Hib and/or HepB can be given as Hib/MenC and/or, monovalent hepatitis B, at 4 week intervals
• b Doses of MenB should ideally be given 8 weeks apart. They can be given 4 weeks apart in order for the primary MenB immunisation schedule to be completed before the first birthday if possible (i.e. if schedule started after 10m of age)
• c First dose of rotavirus vaccine to be given only if infant is more than 6 weeks and under 15 weeks and second dose to be given only if infant is less than 24 weeks old
• d Infants who are aged 12 weeks or over when starting their primary schedule can be given their single infant priming dose of PCV with their first set of primary immunisations
  
  
• Boosters + subsequent vaccination
  • As per UK schedule ensuring at least a 4 week interval between primary DTaP/IPV/Hib/HepB and the booster Hib/MenC dose, and a minimum 4 week interval between MenB and PCV priming and booster doses

Children from first up to second birthday

• DTaP/IPV/Hib/Hepa+ PCVb + Hib/Men Cb + MenBc + MMR
• Four week gap
  • DTaP/IPV/Hib/HepBa
• Four week gap
  • DTaP/IPV/Hib/HepBa + MenBc
• a) DTaP/IPV/Hib/HepB is now the only suitable vaccine containing high dose tetanus, diphtheria and pertussis antigen for priming children of this age. For those who have had primary vaccines without HepB, there is no need to catch-up this antigen alone unless at high risk
• b All un- or incompletely immunised children only require 1 dose of Hib, Men C (until teenage booster) and PCV over the age of 1 year. It does not matter if 2 Hib-containing vaccines are given at the first appointment or if the child receives additional Hib at subsequent appointments if DTaP/IPV/Hib/HepB vaccine is given
• c Children who received less than 2 doses of MenB in the first year of life should receive 2 doses of MenB in their second year of life at least 8 weeks apart. Doses of MenB can be given 4 weeks apart if necessary to ensure the 2 dose schedule is completed (i.e. if schedule started at 22m of age)
  
  
• Boosters + subsequent vaccination
  • as per UK schedule

Children from second up to tenth birthday

• DTaP/IPV/Hib/HepBa + Hib/MenCb + MMR
• Four week gap
  • DTaP/IPV/Hib/HepBa + MMR
• Four week gap
  • DTaP/IPV/Hib/HepBa
• a DTaP/IPV/Hib/HepB is now the only suitable vaccine containing high dose tetanus, diphtheria and pertussis antigen for priming children of this age. For those who have had primary vaccines without HepB, there is no need to catch-up this antigen alone unless at high risk
• b All un- or incompletely immunised children only require 1 dose of Hib and Men C (until teenage booster) over the age of 1 year. It does not matter if 2 Hib-containing vaccines are given at the first appointment or if the child receives additional Hib at subsequent appointments if DTaP/IPV/Hib/HepB vaccine is given
  
  
• Boosters + subsequent vaccination
  • First booster of dTaP/IPV can be given as early as 1 year following completion of primary course to re-establish on routine schedule. Additional doses of DTaP-containing vaccines given under 3 years of age in some other countries do not count as a booster to the primary course in the UK and should be discounted Subsequent vaccination - as per UK schedule

From tenth birthday onwards

• Td/IPV + MenACWY* + MMR
• Four week gap
  • Td/IPV + MMR
• Four week gap
  • Td/IPV
• * Those aged from 10 years up to 25 years who have never received a MenC-containing vaccine should be offered MenACWY. Those aged 10 years up to 25 years may be eligible or may shortly become eligible for MenACWY usually given around 14y of age. Those born on/after 1/9/1996 remain eligible for MenACWY until their 25th birthday
  
  
• Boosters + subsequent vaccination
  • First booster of Td/IPV: Preferably 5 years following completion of primary course
  • Second booster of Td/IPV: Ideally 10 years (minimum 5 years) following first booster
• HPV vaccine
  • females (born on/after 1/9/91) and males (born on/ after 1/9/06) remain eligible up to their 25th birthday
  • eligible individuals age 11 to 25 years should be offered a 2 dose schedule at 0, 6-24 months
  • eligible individuals who are HIV positive or immunocompromised should be offered a 3 dose schedule at 0, 1, 4-6 months
  • if the course is interrupted, it should be resumed but not repeated, even if more than 24 months have elapsed since the first dose
  • individuals who started a 3 dose HPV schedule prior to the schedule change on 1 April 2022 should continue with their planned 3 dose schedule unless:
    • they have had two doses already with a 6 month interval - in which case no further doses are
      needed
    • they have only had one dose 6 or more months ago - in which case they will only require 1 more HPV dose to complete their schedule
    • for individuals who started the schedule with an HPV vaccine no longer/not used in the UK programme, the course can be completed with the vaccine currently being used
    • courses started but not completed before 25th birthday should be completed at the minimum interval (6 months for those following 2 dose course)

Other vaccines:

• MMR - from first birthday onwards
  • doses of measles-containing vaccine given prior to 12 months of age should not be counted
  • 2 doses of MMR should be given irrespective of history of measles, mumps or rubella infection and/or age
  • a minimum of 4 weeks should be left between 1st and 2nd dose MMR
  • if child <3y4m, give 2nd dose MMR with pre-school dTaP/IPV unless particular reason to give earlier
  • second dose of MMR should not be given <18m of age except where protection against measles is urgently required
• Flu vaccine (during flu season)
  • those aged 65yrs and older although recommendations may change annually so always check Annual Flu Letter
  • children eligible for the current season’s childhood influenza programme (see Annual Flu Letter for date of birth range)
  • those aged 6 months and older in the defined clinical risk groups (see Green Book Influenza chapter)
• Pneumococcal polysaccharide vaccine (PPV)
  • those aged 65yrs and older
  • those aged 2yrs and older in the defined clinical risk groups (see Green Book Pneumococcal chapter)
• Shingles vaccine
  • those aged from 70 years up to their 80th birthday

Reference:

• UK Health Security Agency (March 2022). Vaccination of individuals with uncertain or incomplete immunisation status