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Introduction

This guide provides information on the routine vaccinations that are given to children before they start school to help protect them from serious childhood diseases. It describes these diseases and explains why young children need protection against them. It also answers some of the most common questions about pre-school vaccination.

If you have more questions or you want more information, talk to your doctor, practice nurse or health visitor.

You can also visit or call the free NHS helpline 111.

Timetable of pre-school immunisations

The first autumn after your child turns 2 years of age he or she becomes eligible for the nasal flu vaccine. This will be offered every year including once your child starts school. There are other vaccinations due at 3 years and 4 months of age. These vaccines update the protection your child should have received as a baby, at 12 and 18 months of age. You should receive an appointment for you to bring your child for their pre-school vaccinations, contact your GP surgery if you haven’t received this.

The table below shows the vaccines given during the pre-school period your child will be offered. These vaccinations will make sure that your child has the best protection against serious childhood diseases as they grow up.

Vaccine	How and when it is given	Comments
Influenza or flu	Nasal spray Each year from September	This vaccine is given to children aged 2 and 3 years old on 31 August of the current flu season. Children who are in risk groups and cannot have the nasal spray will be offered a vaccination by injection
Diphtheria, tetanus, pertussis (whooping cough) and polio (dTaP/IPV) (4 in 1)	One injection at 3 years and 4 months old	This is a booster dose of these vaccines
Measles, mumps and rubella (MMR)	Children born on or after 1 July 2024 should receive the second MMR at 18 months of age	Any children who have missed their first or second dose of MMR should be offered it at the pre-school visit

°Õ³ó±ðÌýcomplete immunisation schedule from July 2025 is available to view or download and includes:

• routine immunisation schedule
• selective immunisation programmes
• additional vaccines for individuals with underlying medical conditions

Common answers about pre-school immunisations

Immunisations at pre-school age

The pre-school vaccinations, often called pre-school boosters, will update or top up your child’s immune system by reminding it how to fight off certain infections and the diseases they cause. Protection (immunity) against diphtheria, tetanus, whooping cough and polio from the vaccinations given to babies can fade over time. Sometimes, complete immunity to measles, mumps or rubella does not develop after a single dose of the MMR vaccine – so another dose gives them a second chance.

When you take your child for their pre-school vaccinations, it is important to make sure all their other vaccinations are up to date.

The flu vaccine will help protect your child against flu during the winter but will need to be given every year because the viruses that cause flu change very frequently.

How vaccines work

Vaccines contain a small amount of either a weakened form or a carefully chosen part of the germ (the virus or bacterium) that causes a disease. Vaccines work by causing the body’s immune system to develop cells that are programmed to remember the targeted infection. If your child later comes into contact with the infection, these cells will recognise it and rapidly produce antibodies and other substances that fight off infection and help to protect him or her. Because vaccines have been used so successfully in the UK, diseases such as polio have all but disappeared from this country.

Vaccines safety

Before they are allowed to be used, all medicines (including vaccines) are thoroughly tested to assess how safe and effective they are. After they have been licensed, the safety of vaccines continues to be monitored. Any rare side effects that are discovered can then be assessed further. All medicines can cause side effects, but vaccines are among the very safest.

Research from around the world shows that vaccination is the safest way to protect your child’s health.

Immunisation against diseases that are now uncommon in the UK

In the UK, these diseases are kept at bay by high immunisation rates. Around the world, millions of people a year die from infectious diseases with more than 5 million of these being children under the age of 5. Many of these deaths could be prevented by vaccination. As more people travel abroad and more people come to visit this country, there is a risk that they will bring these infections into the UK. The infections may spread to people who are not protected so your baby is at greater risk if he or she has not been vaccinated. Vaccination doesn’t just protect your child; it also helps to protect your family and the whole community, especially those children who, for medical reasons, can’t be vaccinated.

Vaccine side effects

Any side effects that occur are usually mild. Your child may get a little redness, swelling or tenderness where the injection was given that will disappear on its own. Some children may get a fever that can be treated with liquid paracetamol. Read and follow the instructions on the bottle carefully and give your child the correct dose for their age. If necessary, give them a second dose 4 to 6 hours later. If your child’s temperature is still high after they have had a second dose of liquid paracetamol, speak to your doctor or call the free NHS helpline 111.

Allergies to vaccine ingredients

Very rarely, children can have an allergic reaction soon after vaccination. This may be a rash or itching affecting part or all of the body. The doctor or nurse giving the vaccine will know how to treat this. It is not a reason to withhold further vaccinations.

Even more rarely, children can have a severe reaction, within a few minutes of the vaccinations, which causes breathing difficulties and can cause the child to collapse. This is called an anaphylactic reaction. A recent study has shown that there is less than one anaphylactic reaction for every million vaccinations given. The people who give vaccinations are trained to deal with anaphylactic reactions and children recover completely with prompt treatment.

Vaccinating children who have allergies

Asthma, eczema, hay fever, food intolerances and allergies should not prevent your child having the vaccines in the routine childhood immunisation programme. If your child has needed intensive care due to asthma or egg allergic anaphylaxis then further advice should be sought. If you have any questions, speak to your doctor, practice nurse or health visitor.

Children who cannot be immunised

There are very few children who cannot be vaccinated. In general, a vaccine should not be given to children who have had a confirmed anaphylactic reaction to a previous dose of the same vaccine or to a known ingredient of the vaccine.

There are a very small number of children who may not be able to have one or more of the routine vaccines for health reasons. Your health visitor, practice nurse or doctor will ask you about the relevant conditions. You can also speak with them if you are worried about a specific vaccine.

Vaccination during illness

If your child has a minor illness without a fever, such as a cold, they should have their vaccinations as normal.

If your child is ill with a fever, put off the vaccination until the child has recovered. This is to avoid the fever being associated with the vaccine, or the vaccine increasing the fever your child already has.

If your child:

• has a bleeding disorder, or
• has had a fit not associated with fever

speak to your doctor, practice nurse or health visitor before your child has any vaccination.

Fits and seizures following vaccination

Fits are also called seizures or convulsions. Some are associated with fever and some are not.

Seizures associated with fever (which may be called a febrile seizure or febrile convulsion) are rare in the first 6 months of life and are most common in 1 and 2 year olds. After this age, they become less frequent and are rare after the age of 5 years. Sometimes vaccination is followed by a fever that may cause a febrile seizure. Most children who have febrile seizures recover fully.

When a seizure occurs within a short time after vaccinations, it might not have been caused by the vaccine or the fever. It could be due to an underlying medical condition. If your child has a fit after vaccination, you should seek urgent medical advice.

If your surgery is closed or if you can’t contact your doctor, go straight to the nearest hospital emergency department.

Children who cannot receive live attenuated vaccines

The MMR and nasal flu vaccines are live attenuated vaccines (that is, they contain viruses that have been weakened). Children who are ‘immunosuppressed’ may not be able to receive live vaccines.

Children who are immunosuppressed include those:

• whose immune system is suppressed because they are undergoing treatment for a serious condition such as a transplant or cancer, or

• who have any condition which affects the immune system, such as severe primary immunodeficiency. Primary immunodeficiencies are very rare diseases that mean they are more likely to catch infections. They are usually caused by a faulty gene and are diagnosed soon after birth

If this applies to your child, you must tell your doctor, practice nurse or health visitor before the immunisation. They will get specialist advice.

Vaccinations for pre-school children

Flu vaccine

Influenza (flu) and its causes

Flu is an infectious disease with symptoms that come on very quickly. A bad bout of flu can be much worse than a heavy cold. In children, it causes fever, stuffy nose, dry cough, sore throat, aching muscles and joints, and extreme tiredness that can last several days. Flu can lead to a painful ear infection, bronchitis and pneumonia – these may be severe and require admission to hospital.

Flu is caused by influenza viruses that infect the windpipe and lungs. When an infected person coughs or sneezes, they spread the flu virus in tiny drops of saliva over a wide area. These droplets can then be breathed in by other people or they can be picked up by touching surfaces where the droplets have landed.

Nasal spray vaccination against flu

The vaccine is given as a nasal spray up each nostril. It is quick and painless. The vaccine contains viruses that have been weakened to prevent them from causing flu but will help your child to build up immunity, so that when they come into contact with the flu virus they are unlikely to get ill.

Benefits of the vaccine

Having the vaccine will help protect your child from what can be a very nasty illness in children. Children under the age of 5 years have one of the highest rates of hospital admissions due to flu. Very rarely young children can die of flu.

It will also reduce the chance of others in your family, who could be at greater risk from flu, such as grandparents or those with long term health conditions, getting flu from your child.

It can help you avoid having to take time off work, or other activities, to look after your sick child or if you become sick yourself.

Reasoning for annual flu vaccination

The viruses that cause flu change very frequently, so the vaccine has to be changed to match the viruses and may differ from year to year. The vaccine your child gets this year may well be different from the one they had last year, and next year’s may be different again.

Children’s eligibility for the flu vaccine

Children who are 2 and 3 years old on or after 31 August are offered flu vaccination at their GP practice before flu vaccinations start in the autumn are offered flu vaccination at their GP surgery, usually by the practice nurse.

In addition other children are offered the flu vaccine every year

• all primary school-aged children
• some secondary school-aged children (years 7 to 11)
• children aged 6 months to 18 years with certain medical conditions

Please see the flu collection for full details of flu eligibility.

Flu vaccination side effects

Serious side effects are uncommon but many children can develop a runny or blocked nose, headache, some tiredness or loss of appetite that last for a short period. The vaccine is absorbed quickly in the nose so, even if your child sneezes immediately after having had the spray, there’s no need to worry that it hasn’t worked.

The nasal flu vaccine is called Fluenz, you can view the .

Children who should not have the nasal vaccine

Children may not be able to have the nasal vaccine if they:

• are currently wheezy or have been wheezy in the past 72 hours, they should be offered an injected flu vaccine to avoid a delay in protection

• have needed intensive care due to:

  • asthma
  • an anaphylactic reaction due to an egg allergy (children in these 2 groups are recommended to seek the advice of their specialist and may need to have the nasal vaccine in hospital)
• have a condition, or are on treatment, that severely weakens their immune system or have someone in their household who needs isolation because they are severely immunosuppressed
• are allergic to any other components of the vaccine (See the for a list of the ingredients of the vaccine)

If your child can’t have the nasal flu vaccine they should have the flu vaccine by injection.

As children with pre-existing medical conditions may be more vulnerable to complications of flu it is especially important that they are vaccinated.

If you are unsure whether your child should get the injected vaccine or the nasal vaccine please check with the nurse or GP at your surgery.

Children who have been vaccinated with the nasal spray should avoid household contact with people with very severely weakened immune systems (for example those who have just had a bone marrow transplant) for around 2 weeks following vaccination.

The nasal flu vaccine and porcine gelatine

The nasal vaccine is the preferred vaccine for children. It contains a highly processed form of gelatine (derived from pigs), which is used in a range of many essential medicines.

The nasal vaccine provides good protection against flu, particularly in young children. This nasal vaccine not only protects your child against disease but, if enough children are vaccinated, the disease won’t spread from one person to another, and so their friends and family are also protected.

For those who may not accept the use of porcine gelatine in medical products, an injected flu vaccine is available as an alternative. This vaccine also works very well in children. Further information about porcine gelatine and the nasal flu vaccine is available.

There are also translated versions in , , , , and available.

dTaP/IPV vaccine

Booster given at 3 years 4 months.

This vaccine boosts the vaccinations that were given to your child at 8, 12, 16, weeks and at 18 months of age. It protects against diphtheria, tetanus, pertussis (whooping cough) and polio.

Diphtheria

Diphtheria is a serious disease that usually begins with a sore throat and can quickly develop to cause breathing problems. It can damage the heart and nervous system and, in severe cases, it can kill.

Tetanus

Tetanus is a disease affecting the nervous system which can lead to muscle spasms, cause breathing problems and can kill. It is caused when germs that are found in soil and manure get into the body through open cuts or burns. Tetanus cannot be passed from person to person.

Pertussis (whooping cough)

Whooping cough is a disease that can cause long bouts of coughing and choking making it hard to breathe. Whooping cough can last for up to 10 weeks. It is not usually so serious in older children, but in babies it is very serious and can kill.

Polio

Polio is a virus that attacks the nervous system which can cause permanent paralysis of the muscles. If it affects the chest muscles or the brain, polio can kill.

dTaP/IPV vaccination side effects

Your child may have some redness, swelling or tenderness where they had the injection, but this will usually disappear in a few days.

A hard lump may appear in the same place but this will also go, usually over a few weeks. Occasionally, children may be unwell and irritable and develop a temperature, headache, sickness and swollen glands.

The booster offered at this age is Boostrix-IPV, for further information on this vaccine see the .

MMR vaccine

For children born before 1 July 2024, a second dose of MMR is given at 3 years and 4 months.

Children born on or after 1 July 2024, should have been offered their second dose of MMR at 18 months.

The MMR vaccine protects against measles, mumps and rubella. Since 1988, when the MMR vaccine was introduced in the UK, the numbers of cases of measles, mumps and rubella have dramatically reduced.

Measles and how it is spread

Measles is caused by a very infectious virus. Nearly everyone who catches it will have a high fever, a rash and generally be unwell. Children often have to spend about 5 days in bed and could be off nursery or school for 10 days. Adults are likely to be ill for longer. The complications of measles affect 1 in every 15 children. The complications include chest infections, fits, encephalitis (infection of the brain), and brain damage. Measles can kill.

Measles is one of the most infectious diseases known. A cough or a sneeze can spread the measles virus over a wide area. Because it’s so infectious, the chances are your child will get measles if he or she is not protected and comes near to someone who has measles. Over 95% of children need to be vaccinated to prevent measles from circulating and causing outbreaks.

Mumps and how it is spread

Mumps is caused by a virus which can lead to fever, headache, and painful, swollen glands in the face, neck and jaw. It can result in permanent deafness, viral meningitis (infection of the lining of the brain) and encephalitis. Rarely, it causes painful swelling of the testicles in males and the ovaries in females. Mumps lasts about 7 to 10 days. Before the MMR vaccine was introduced, mumps was the most common cause of viral meningitis in children under 15.

Mumps is spread in the same way as measles. It is about as infectious as flu.

Rubella and how it is spread

Rubella (German measles) is a disease caused by a virus. In children it is usually mild and can go unnoticed. It causes a short-lived rash, swollen glands and a sore throat. Rubella is very serious for unborn babies. It can seriously damage their sight, hearing, heart and brain. This condition is called congenital rubella syndrome (CRS). Rubella infection in the first 3 months of pregnancy causes damage to the unborn baby in up to 9 out of 10 cases. In many of the cases, pregnant women caught rubella from their own, or their friends’ children.

Rubella is spread in the same way as measles and mumps. It is about as infectious as flu.

Reasoning for second MMR dose

Measles and mumps are circulating in the UK. Children who are not protected are still at risk of catching the infections. Your child needs a second dose of MMR because the vaccine doesn’t always work fully the first time. Some children who have only one dose of the vaccine might not be protected against one or more of the diseases. If your child didn’t have their first or second doses of MMR they can have it at their 3 year 4 months appointment.

However these diseases have not gone away and there have been outbreaks of measles in recent years. Two doses of the MMR vaccine are routinely given across Europe as well as in the US, Canada, Australia and New Zealand. Immunising your child with 2 doses of the MMR vaccine will give them the best protection.

Side effects from the second (pre-school) dose of the MMR vaccine

It is much less common to have side effects after the second dose than after the first dose. When side effects do happen, they are usually very mild:

• the 3 different viruses in the vaccine act at different times and produce the following side effects after the first dose of vaccine
• 6 to 10 days after the immunisation, about one in ten children may develop a mild fever and some develop a measles-like rash and go off their food — this can happen when the measles part of the vaccine starts to work, and is normal
• about one in every 1,000 immunised children may have a fit caused by a fever — this is called a ‘febrile convulsion’, and can be caused by any fever; however, if a child who has not been immunised gets measles, they are 5 times more likely to have a fit
• rarely, children may get mumps-like symptoms (fever and swollen glands) about 3 weeks after their immunisation as the mumps part of the vaccine starts to work
• very rarely, children may get a rash of small bruise-like spots in the 6 weeks after the vaccination, this is usually caused by the measles or rubella parts of the vaccine — if you see spots like these, take your child to the doctor to be checked and they will tell you how to deal with the rash; as this rash could be confused with the rash caused by septicaemia you should contact your doctor urgently if your child is also unwell
• fewer than one child in a million develops encephalitis (inflammation of the brain) after MMR vaccine, however, if a child catches measles, the chance of developing encephalitis is about one in 1,000
• some years ago, there were stories suggesting a link between the MMR vaccine and autism. Research since then has proved that no such link exists

Live attenuated vaccination cannot spread disease

No, your child will not be infectious. It contains weakened versions of live measles, mumps and rubella viruses. Because the viruses are weakened, people who have had the vaccine cannot infect other people.

MMR and porcine gelatine

In the UK we have 2 MMR vaccines. Both work very well, one contains porcine gelatine and the other doesn’t. If you want your child to have the porcine gelatine free vaccine discuss it with your practice nurse or GP.

You can view the MMR vaccine patient information leaflets at:

Egg allergies

The MMR vaccine can safely be given to children who have had a severe allergy (anaphylactic reaction) to egg. If you have any concerns, talk to your practice nurse, health visitor or doctor.

Meningitis and septicaemia

Meningitis and septicaemia

Meningitis is an infection of the lining of the brain. The same germs that cause meningitis may cause septicaemia (blood poisoning). Both meningitis and septicaemia are very serious in young children and the signs can come on quickly.

If you suspect meningitis or septicaemia get help urgently.

Although your child was vaccinated as an infant against Hib, MenB and some forms of pneumococcal bacteria, all of which cause meningitis and septicaemia, these vaccines will not protect them against other types of meningitis and septicaemia. So it’s important to know the signs and symptoms.

Meningitis and septicaemia signs and symptoms

Early symptoms of meningitis and septicaemia are mild and are similar to the symptoms of flu (for example, fever, vomiting, being irritable and pain in the back or joints). Symptoms can occur in any order and some may not appear at all.

The most important signs of meningitis to look out for in children are:

• a stiff neck (check that your child can kiss their knee, or touch their forehead with their knees)

• a bad headache (this alone is not a reason to get medical help)

• a dislike of bright lights

• vomiting

• fever

• drowsy, less responsive and confused

• stiff with jerky movements (convulsions or fits)

• a rash

The main signs of septicaemia are:

• sleepiness, less responsive, vacant or confused (a late sign)

• severe pains and aches in the arms, legs and joints

• very cold hands and feet

• shivering

• rapid breathing

• red or purple spots that don’t fade when you press them (information on the glass test below)

• vomiting

• a fever

• diarrhoea and stomach cramps

What to do with suspected meningitis and septicaemia

If your child develops one or more of the symptoms described above, get medical help urgently. If you can’t get in touch with your doctor, or are still worried after getting advice, trust your instincts and take your child to the nearest hospital with an emergency department.

The ‘glass test’

Press the side of a clear drinking glass firmly against the rash so you can see if the rash fades and loses colour under pressure. If it doesn’t change colour, contact your doctor immediately.

On dark skin, check inside the eyelids or roof of the mouth where the spots maybe more visible.

Where to get more information

If you would like more information about MMR please visit the .

If you would like more information on the MMR you can read the MMR for all leaflet.

Information on meningitis is available on the .

The following charities provide information, advice and support:

• , free helpline 0808 8003 344 - Monday to Friday, 9am to 5pm

• , free helpline 0808 8010 388 Monday to Thursday 9am to 4pm and Fridays 9am to 1pm

Travel advice for children

If your child is going abroad, make sure their routine immunisations are up to date. Your child may also need extra immunisations and you may also need to take other precautions.

Contact your doctor’s surgery or a travel clinic well in advance for up-to-date information on the immunisations your child may need.

You can get more information from and .

Vaccine Damage Payment Scheme

Current immunisations are extremely safe but, very rarely, an individual may suffer from a problem after vaccination.

The Vaccine Damage Payment Scheme is designed to ease the present and future burdens of the person who, on that very rare occasion, may be affected by the vaccination.

There are several conditions that need to be met before a payment can be made. More information on Vaccine Damage Payment is available.

For more information visit the .

If you want advice on immunisation, speak to your doctor, practice nurse, health visitor or pharmacist, or call the NHS helpline 111.

Find more on NHS.UK.

Order or download print copies

Paper copies of this leaflet are available free to or download.