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00:00:22.422Hello and welcome to this Dovetail Medical Events snippet on the changes to the UK immunisation schedule.
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00:00:25.692My name is Ashley and I'm a practice nurse myself.
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00:00:36.855In this session we'll talk through the changes to the UK immunisation schedule and aim to make it simpler to understand, because there is a lot to consolidate.
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00:00:48.134If you're particularly concerned or overwhelmed at the minute, I would focus primarily on the changes to the primary and one year immunisations.
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00:00:52.722First, the primary and one-year immunisations first.
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00:00:59.762As we know, these changes were implemented from the 1st of July 2025, while the further changes we do have until the 1st of January 2026 to get our heads around.
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00:01:04.935But hopefully after this session it will be a little bit clearer.
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00:01:17.656They will go through the changes for each sort of section of the immunisation schedule and will also touch on the incomplete algorithm as well.
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00:01:39.391So what we need to know from the 1st of July 2025, menb will be offered at 8 and 12 weeks to all who present for those appointments and PCV will be at 16 weeks, and this is due to an earlier presentation of meningitis B cases in babies.
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00:01:47.266Menitrix manufacturing is ceasing and stocks are expected to be exhausted by mid-25.
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00:01:58.789Meningitis C vaccination in early childhood is not considered necessary due to the success of the teenage meningitis ACWI campaign.
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00:02:04.143But vaccination against Hib must continue in the second year of life.
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00:02:12.034So therefore, an additional dose of 6-in 1 will be given at 18 months of age to meet that Hib requirement.
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00:02:27.555This new 18 month of age appointment will allow for the second dose of MMR to be brought forward from three years four months and that will allow for a address in the rise in measles cases.
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00:02:49.326From the 1st of July 2025, miniterics will no longer be offered at 12-month immunisation appointments for selected demographics depending on their date of birth, which we'll go through, and then, from the 1st of January 26, an additional six in one will be offered at the new 18-month immunisation appointment.
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00:02:58.859So this is a lot of changes and I think it's really important that we understand why these changes have been implemented.
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00:03:08.155And firstly, meningitis B cases in babies previously peaked between five and six months of age.
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00:03:15.664Between five and six months of age, meningitis B cases in babies now peaks between one and three months.
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00:03:21.783So previously most babies would have at least been offered their vaccination before the peak instance of the disease.
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00:03:37.271However, now the disease peak is much younger and so early protection is vital and so getting the most babies we can onto the new schedule as soon as we can is essential, hence why date of birth doesn't matter for this change.
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00:03:46.342We then need to think about HIB, and we need to continue offering HIB over one year of age due to the number of instances.
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00:04:01.467Now, obviously, the UK HSA presentation went into a lot of detail about the rationale for the changes and all of that, so I'm not going to repeat too much, as the purpose of this session is to make it easy read, if you like.
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00:04:09.632We're then thinking about bringing the second dose of MMR forward to combat the rising number of measles cases.
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00:04:13.722So that's the rationale for the changes that have come about.
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00:04:18.312So how will this look in our practice?
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00:04:27.303And we're going to break down these changes into a step-by-step process, beginning with those changes that come into effect from the 1st of July.
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00:04:30.973We'll look through the primary immunisations changes.
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00:04:38.122Then we'll move on to the one-year immunisations and the need for date of birth consideration at those appointments.
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00:04:51.690Then we'll look at the plan changes from the 1st of January 2026, and then we will look at babies born to hepatitis B positive mothers and how these changes will impact their immunisations.
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00:04:59.274Ok, so primary immunisations Again, if we're feeling overwhelmed.
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00:05:08.592I would focus on the changes to the primary immunisations and the one year immunisations first, as these have been implemented from the 1st of July 2025.
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00:05:10.343Obviously, we've got a little bit longer.
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00:05:15.674For the other changes We've got until the 1st of January 2026 when the further changes come into effect.
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00:05:24.810The primary principle of the changes to the primary immunisations are that date of birth should not be used to establish any changes.
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00:05:29.824This is to ensure that most babies are moved onto the new schedule as soon as possible.
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00:05:36.835As previously stated, this is due to the shift in age of presentation of meningitis B instances.
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00:05:41.366So let's go through each appointment.
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00:05:44.753So eight week immunisations no change there.
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00:05:46.725Absolutely nothing different at all.
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00:05:47.689That's nice and easy.
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00:05:55.597I would reiterate that the Green Book guidelines we do not need to wait for a GP check or child health notification, anything like that.
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00:06:01.536If a baby is eight weeks of age, we can commence them on the UK schedule for immunizations.
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00:06:10.125There's actually nothing within the GP check that would contraindicate or impact on immunizations as long as the baby is well.
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00:06:16.290But as competentizers we're going to be assessing whether they are well enough for immunization anyway.
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00:06:21.993But nothing that the GP would check would impact on our decision to immunize.
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00:06:23.427It would be our own assessment.
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00:06:26.689So, eight-week immunizations, no changes.
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00:06:35.582Twelve-week immunizations, and obviously we're recording today after the 1st of july, uh 25.
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00:06:46.785So that makes it a little simpler that any baby presenting um now will um have the new schedule if they're presenting for their second immunizations.
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00:06:59.590But just popping back, thinking, 12-week immunisations, thinking is the date the baby attends for their second primary immunisations after the 1st of July 2025.
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00:07:07.142If the date we are giving them their second lot of immunisations, their 12-week M's, so it doesn't matter if they've come late.
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00:07:21.831I actually I kind of wish we referred to them as first, second and third primaries instead of 8, 12 and 16 weeks, because I do think sometimes we get focused on the age and, and you know, um get a little bit uh distracted by that.
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00:07:24.722So it's their second set of immunizations.
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00:07:31.497If it's after the 1st of July 2025, yes, then we're going to be using the new schedule.
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00:07:34.743We're not going to be using the date of birth for this.
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00:07:56.047So, while there is a brilliant calculator on health publications that has been used, there is a disclaimer on it that says it shouldn't replace clinical judgment and, unfortunately, because the calculator is used with an Excel spreadsheet, it has to embed formulas and for it to work, that has to include date of birth.
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00:07:59.501It will assume that babies are not attending late.
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00:08:07.302So it will assume that if they turn 12 weeks, you know, on the 30th of June, it'll assume they're attending then.
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00:08:17.611So it can't factor in the fact that babies may be attending at different times to the actual date they tick over to that age.
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00:08:23.211So don't use date of birth for the changes to the primary immunisations.
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00:08:27.003All we have to think about is the date we're giving these vaccines.
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00:08:30.770After the 1st of July, obviously it will be now.
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00:08:44.971So we're going to be using the new schedule and we're going to be getting as many babies as possible offered their second MenB at 12 weeks, 16 week immunisations.
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00:08:59.026So this is the appointment that I do think we really need to be careful about, as I think this is the one that has the potential for errors I'm sure we all do but just taking the time to check every time what the baby's received previously.
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00:09:25.535Because if they have had the 12-week immunisations as per the old schedule, so if they attended for their 12 weekends before the 1st of July, then we have to continue the old schedule, remembering that the primary course of immunisations given over the three appointments should include three doses of 6-in-1, two doses of Membi, two doses of Rota and one dose of PCV.
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00:09:28.349So we need to be checking what they've had previously.
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00:09:32.364So we need to be checking what they've had previously.
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00:09:37.379If they've either come before the 1st of July or, in error, they followed the old schedule, we'd need to give what's outstanding.
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00:09:42.632So and this is where we'd look at this chart so obviously it's after the 1st of July.
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00:09:46.050Now we're going to be checking what they've had at their 12 weekends.
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00:09:59.091If their 12 weekends were given as per the old schedule, meaning they had six in one rota and pcv, if their 12-week IMS were given as per the old schedule, meaning they had 6-in-1 rota and PCV at their 12-week IMS, they still need their second dose of an MB.
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00:10:03.305So we're then going to have to follow the old schedule and give a 6-in-1 and an MB.
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00:10:14.682If they had their 12-week IMS as per the new schedule, that means that at their 12 weekends they received six in one rota and then B.
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00:10:19.291We therefore need to be offering PCV because they won't have had that yet.
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00:10:24.925Okay, so that's the changes for the primary immunizations.
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00:10:51.596Remembering date of birth is irrelevant here we're essentially swapping the MenB dose with the PCV dose if it's after the 1st of July, really being mindful of our 16 week appointments and checking what they've already had, because we don't want to miss a PCV dose by giving a third MenB at 16 weeks because we've just moved everybody onto the new schedule.
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00:11:03.572We need to be looking at what they've had, because there will be babies who are attending perhaps on the same day in the same IMS clinic and that their previous appointment might have been a day or two.
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00:11:13.822Either side of the 1st of July change date and so they may be having different immunisations based on what they previously had.
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00:11:22.704So, really taking the time to check what they've previously been given, okay, one-year immunisations.
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00:11:33.202So this is where it becomes a little bit more intricate and this does depend on a child's date of birth and we have to remember some babies are coming late.
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00:11:35.187We have to be mindful of the late attenders.
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00:11:47.026So, again, checking their date of birth before giving anything, as I'm sure we do, checking their date of birth, checking what they've previously had and then checking how they would fit into the new schedule.
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00:11:59.768So, for children born on or after the 1st of July 2024, for these children, we move straight on to the new schedule.
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00:12:02.699These children should not be offered minotaurics.
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00:12:07.488At one year immunisations we're giving MMR, menb and PCV.
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00:12:13.476These children will be offered an 18-month immunisation appointment.
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00:12:20.670So children whose date of birth is on or after the 1st of July 2024.
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00:12:25.367Now I think this is the simpler part of the one-year immunisations change.
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00:12:31.163Obviously, as we should anyway, we'll be checking that they've had their primaries, that they've not missed any, any of those.
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00:12:37.000But for children born on or after the 1st of July 2024, we're onto the new schedule.
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00:12:44.379Now, the way I think of it is, the 1st of July 2025 is the date that we changed the schedule.
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00:12:57.846So those children it'll have either been their birthday on that day or after that day, so they won't have been one when the changes took effect.
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00:13:01.033So those ones move on to the new schedule.
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00:13:11.773Now for children born on or before the 30th of June 2024, these children will remain on the old schedule.
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00:13:20.133Therefore, at the one-year immunisations we're going to be administering MMR, menb, pcv and Minitrix, as we always have.
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00:13:24.407These children should still be offered a Hib containing vaccine.
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00:13:30.569These children will not be offered an 18-month vaccination appointment routinely.
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00:13:35.791They will routinely be offered their next immunisations at three years, four months.
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00:13:45.807If stocks of minotaurics are extinguished before these children present, then we're to give an additional dose of 6-in-1 in place of the minotaurics.
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00:13:50.230Therefore, we'd be administering MMR, memb, pcv and 6-in-1.
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00:14:01.787So this is a little bit more complicated and we will go over the incomplete algorithm shortly, but it's for those children whose date of birth is on or before the 30th of June 2024.
00:14:01.787 -->
00:14:04.112So, essentially, they are going to have.
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00:14:17.271They may not have been invited for their IMS yet, they may not have presented for the rims, but on the day that the schedule changed, which was the 1st of July 2025, on that date, those children will have already been one.
00:14:17.271 -->
00:14:21.706So that that's a way that I've thought of of looking at it.
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00:14:31.110Because of their date of birth, they will have already been one, and I do believe Wales have been advised slightly differently.
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00:14:35.949So if anybody is practicing in wales, then obviously follow your local guidance.
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00:15:00.560I believe you had a hard swap from miniaturics to six in one but, um, obviously following your local guidance and for everywhere else this would apply, um, so, yeah, if, if children were already one when the changes took effect, so if their date of birth was on or before the 30th of june 2024, then this is how we would proceed.
00:15:04.170 -->
00:15:07.098So that's it for the changes to one year immunizations.
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00:15:09.242We're going to be remembering to check date of birth.
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00:15:23.120Also, not to panic if a child should have been offered Minitrix and you can't order it anymore, we're giving six in one instead.
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00:15:28.485If you miss Minitrix, or six in one to somebody who should have received it in error, then not to worry, we can call them back in to administer.
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00:15:35.339They will not be routinely called for their 18 month appointment because of their date of birth.
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00:15:43.359So we need to be making sure that we are giving that Hib containing vaccine over the age of one.
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00:15:57.311So that's why we would do that, so we wouldn't be sort of waiting until 18 months or anything like that, be sort of waiting until 18 months or anything like that.
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00:16:00.504If we do realise that an error has occurred, then we would call them back in as soon as we're aware of that.
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00:16:05.331So changes from the 1st of January 2026.
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00:16:15.709So again, if what we've all been through just is a little bit much, then we've got six months to embed our knowledge and come back to this.
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00:16:29.689Obviously, nursing is a constantly growing and changing profession and learning is continuous, so there's no harm in revisiting this later, but changes from the 1st of January 2026.
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00:16:39.514So, thinking about this new 18-month immunisation appointment, it will be offered to those children who essentially who followed the new one-year schedule.
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00:16:47.314This will bring the fourth dose of 6-in-1 and it will pull forward the second MMR.
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00:16:53.348However, at the minute it's not for all children.
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00:17:00.779It's only for those who were born after the 1st of July 2024 and who followed the new schedule for one year immunisations.
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00:17:09.057So this will mean those children will no longer be offered a second MMR at three years.
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00:17:34.805Four months For all of the ones who followed the new one year schedule and who've had an 18 month appointment, um, thinking about their date of birth, though, uh, the changes to the preschool boosters won't actually come into effect, um, until sort of november 2027, because it only applies to those born after the 1st of July 2024.
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00:17:38.594So they won't reach preschool booster age until November 2027.
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00:17:43.030So really don't worry about the changes to the the preschool boosters at the minute.
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00:17:46.959Just be aware of it and be conscious of that.
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00:17:54.902So, 18 month immunizations really be mindful of late attenders.
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00:17:59.894Check they've had their one-year and they they've um had what they should have had at that appointment?
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00:18:01.557Um, I'm sure we do.
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00:18:19.894But just getting into the habit of every appointment checking their previous ends to ensure nothing's been missed, uh, just embedding that as part of one of your checks that you you go through before um, before administering um, personally, I like to talk it aloud to myself in my room.
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00:18:29.331I'll say their age, date of birth, I'll read through what they've had before um and then have the most up-to-date schedule um there on my second screen and read through that.
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00:18:36.651That's my way of second checking and I guess it's sort of replacing the second checker that you'd have in secondary care.
00:18:36.651 -->
00:18:40.446And I personally like to get things ready with no distractions.
00:18:40.446 -->
00:18:44.014But we've obviously all got ways of working and things that work for us.
00:18:44.014 -->
00:18:48.453But it is worth having some sort of extra layer of checks.
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00:18:55.931While all these changes are afoot, and thinking about times, you could be seeing babies for the same type of appointment.
00:18:55.931 -->
00:19:00.786For example, a couple of weeks ago in clinic I had two one-year-olds back to back.
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00:19:13.742Their dates of birth were a few days apart, but it meant I was giving them different IMS, or well, it meant one of them was having menitrix, one of them wasn't one of them.
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00:19:17.211I was saying their next immunisations would be three years, four months.
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00:19:20.168One of them, I was saying their next would be 18 months.
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00:19:22.514So be mindful of that.
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00:19:43.808I also think come January and we start inviting some babies for 18-month appointments, parents are going to get wind of that and so they may proactively book in um their baby for an 18 month immunization appointment, but because of that baby's a day to birth, they wouldn't actually be eligible.
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00:19:53.114So, thinking about the one-year-olds that I immunized a couple of weeks ago, they, they could, you know, they could well go to the same um sort of nursery and things.
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00:20:06.076Parents, parents, chat, the mum of the one born in June could book them in for an 18 month appointment, thinking that, you know, oh, we've just not been invited yet, but actually because of that child's date of birth, they wouldn't be eligible.
00:20:06.076 -->
00:20:14.424And so it's being careful of that and being able to confidently address those conversations with parents if they have questions.
00:20:14.424 -->
00:20:23.710You know, because they may well ask well, why is you know, so-and-so, two doors down had immunisations at 18 months and my child hasn't?
00:20:23.710 -->
00:20:36.832And it's explaining that actually that's because your child will have had a Hib containing vaccine in their one-year IMS, whereas you know, child two doors down, who's having an 18 month appointment wouldn't have been offered that.
00:20:36.832 -->
00:21:00.808So yeah, just being familiar with and confident with navigating those conversations, so three-year four-month immunisations, changes to the three-year four-month immunisations, as we've said, realistically aren't going to happen until interested three-year four-month immunizations, as we've said, realistically aren't going to happen until, in practice, until the 1st of November 27 when those children with the relevant dates of birth reach that age.
00:21:01.912 -->
00:21:06.324All children who were born, as we said, on or after the 1st of July 2024.
00:21:06.324 -->
00:21:14.725They will have been offered the new immunization schedule at one year of age they will have been offered an 18 month immunisation appointment.
00:21:14.725 -->
00:21:18.875They won't turn three years four months until November 27.
00:21:18.875 -->
00:21:24.550But for those children they will only need four in one at three years four months.
00:21:24.550 -->
00:21:36.243For all of the children whose birthday is 30th of June 24 or before, they'll continue on their schedule that they are currently on.
00:21:36.243 -->
00:21:40.537So they will continue to be offered the second MMR at three years four months.
00:21:41.539 -->
00:21:45.549Obviously some areas bring that forward to 18 months already now anyway.
00:21:45.549 -->
00:21:56.770So if that applies to your local area, then obviously you keep doing what your local area does and I'm thinking, for example, some of the London boroughs routinely have MMR given at 18 months.
00:21:56.770 -->
00:21:59.199It's areas where we've got higher instances.
00:21:59.199 -->
00:22:03.891So if your area has already got its own guidance etc.
00:22:03.891 -->
00:22:05.374Then you carry on as that.
00:22:05.374 -->
00:22:15.239This is just broadly speaking and again we're checking every time we see them what they've had before, what they're eligible for as well.
00:22:15.239 -->
00:22:21.957So that's it for the changes from the 1st of January 2026.
00:22:23.120 -->
00:22:31.956There is also the highly likely addition of varicella, the chickenpox vaccine in the form of an MRV vaccine.
00:22:31.956 -->
00:22:34.519So it would be measles, mumps, rubella and varicella.
00:22:34.519 -->
00:22:41.152At present we do have some possible schedules, but nothing official.
00:22:41.152 -->
00:22:45.370So since we don't have anything official, we'll park that for now.
00:22:45.370 -->
00:22:52.596It is likely it has been mentioned in the sort of 25, 26 GP contract.
00:22:52.596 -->
00:23:03.598So it is highly likely that it will be introduced and they have outlined a potential catch-up campaign, but there hasn't been anything definitive yet.
00:23:03.598 -->
00:23:09.278But just be mindful, that's potentially gonna happen, highly likely.
00:23:11.906 -->
00:23:19.309So babies born to hepatitis B positive mothers really specific demographic and so the following only applies to those babies.
00:23:19.309 -->
00:23:28.007So children born on or after the 1st of July 24 and their mums have hepatitis B.
00:23:28.007 -->
00:23:33.471So they will no longer be offered monovalent hep B at 12 months of age.
00:23:33.471 -->
00:23:40.235They'll receive hep B containing vaccine at 18 months of age in the form of their six in one.
00:23:40.235 -->
00:23:46.440The dry blood spot testing can be undertaken at any time between one year and 18 months of age.
00:23:46.440 -->
00:23:56.728We've we've always done it with the 12 month immunisation, so I would personally see no reason to change that practice.
00:23:56.728 -->
00:24:00.536Um, obviously, whoever's carrying out that that test in your area will carry on.
00:24:00.536 -->
00:24:04.981So if that's um, if that's you in general practice, or if you have another service health visitor etc.
00:24:04.981 -->
00:24:08.669That are helping with that in your area, that should continue as it as it is.
00:24:08.669 -->
00:24:14.057Uh, but the guidance says it can be done at any time between one year and 18 months of age.
00:24:14.057 -->
00:24:23.105This does not affect the doses of monovalent hep B that should be administered at birth and four weeks of age.
00:24:23.105 -->
00:24:28.837And again, whoever is currently giving those in your area will continue to do so.
00:24:28.837 -->
00:24:44.016So Children born on or before the 30th of June 24 and whose mums have hepatitis B, so they will continue to be offered monovalent hep B at one year vaccinations.
00:24:44.016 -->
00:25:03.957If they are immunised as per the old schedule and stock of minotaurics remains, then we're to administer MMR, menb, pcv, hib and MenC and monovalent HepB If we have no stock of miniterix before this child presents.
00:25:03.957 -->
00:25:14.118So if we've run out, then we would replace that miniterix with a six in one, exactly the same as we would for babies whose mothers do not have hepatitis B.
00:25:14.118 -->
00:25:26.890So that would therefore mean, though, that the 6-in-1 we are giving in place of miniterix, if we ran out, would meet the hepatitis B requirement.
00:25:26.890 -->
00:25:35.118So, if we're using 6-in-1 instead, 6 in 1, instead of Miniterix, we'd give MMR, menb, pcv and 6 in 1.
00:25:35.118 -->
00:25:50.568And again, this does not affect the doses of monovalent Hep B that should be administered at birth and four weeks of age for these babies whose mothers have Hepatitis B, and whoever is currently given that monovalent Hep B should continue to do so.
00:25:50.568 -->
00:25:54.375That's it for the upcoming changes.
00:25:54.916 -->
00:25:59.010I do think chunking it into different steps or stages is quite helpful.
00:25:59.010 -->
00:26:10.387It makes it manageable, as it can be a little bit unnerving when there's lots of changes happening all at once, and so hopefully, this has made it a little bit simpler to understand.
00:26:10.387 -->
00:26:30.809When I had, you know, clinic, with babies back to back being given slightly different, I did have to take a minute and think right, okay, let me work through this, um, with no distractions, and let me get my head around what we're doing, even though you know I I felt I was quite happy with the changes.
00:26:30.809 -->
00:26:35.978In practice, when you've got that in front of you in a busy clinic, it is just taking a moment.
00:26:35.978 -->
00:26:45.966It will take time to get used to it and, honestly, mistakes are probably going to happen and so we just need to address and action those as we normally would.
00:26:45.966 -->
00:26:56.560Um it's you know, um, we've got lots of other things that we're doing in clinic, so it is difficult to get everything right 100% of the time.
00:26:56.560 -->
00:27:08.298But, remembering it's highly unlikely that this would cause harm, we'd just move them back onto whatever schedule we should have followed as soon as possible.
00:27:08.298 -->
00:27:18.967You know, for example, if we inadvertently give a miniaturix to somebody who's born on the 1st of july, it's not going to do harm because if they'd have been born the day before they'd have, they'd have got that.
00:27:18.967 -->
00:27:27.931It's just addressing it as we would normally, um contacting the relevant teams, speaking with the parents as as we would normally.
00:27:27.931 -->
00:27:37.488Uh, but I think uk hsa have acknowledged that that there may be some errors, um, and it's just being transparent and addressing it as we would normally.
00:27:40.212 -->
00:27:41.797So the incomplete algorithm.
00:27:41.797 -->
00:27:44.488We're going to find the correct column for age.
00:27:44.488 -->
00:27:52.332We're going to read the whole column in its entirety before making any decisions, including the subsequent doses.
00:27:52.332 -->
00:28:01.158Sometimes it's helpful to cross off what's already been administered, but in some instances that can actually be a little bit confusing.
00:28:01.158 -->
00:28:02.027So we'll go through that.
00:28:02.027 -->
00:28:09.348General principles of immunisation we would never restart a course and again, we cannot over-immunise.
00:28:10.550 -->
00:28:13.394Now, I used to love the old algorithm.
00:28:13.394 -->
00:28:26.977I'm not saying I dislike the new one, but I have to be honest there was a little bit that I wasn't quite sure on, and so I did reach out to UK HSA for some further clarification, which they thankfully provided.
00:28:26.977 -->
00:28:30.165So we'll talk through a few bits on it.
00:28:30.165 -->
00:28:51.165Now the best, I think the best advice I could give is to really take time with this one and read the whole column down before you make any decision, because sometimes there's things further down the column that in certain situations sort of contradicts what's higher up.
00:28:51.165 -->
00:28:56.458Now the general principles section here is helpful.
00:28:56.458 -->
00:29:00.752It highlights that we should aim to offer the most protection in the least visits.
00:29:00.752 -->
00:29:03.450So we'll work through it.
00:29:03.644 -->
00:29:06.694The first column eight weeks up to first birthday.
00:29:06.694 -->
00:29:12.905Remember, if baby comes on their first birthday they're gonna be following the next column along, anyway.
00:29:12.905 -->
00:29:16.652So first column eight weeks up to first birthday.
00:29:16.652 -->
00:29:23.708So let's say they present for the first IMS over the age of 16 weeks.
00:29:23.708 -->
00:29:37.951If we look down here, we can give PCV at that first appointment if they present for their first immunisations over 16 weeks.
00:29:37.951 -->
00:29:41.365I'm getting close to trying to see it on my screen because it's quite small.
00:29:43.135 -->
00:29:58.324Remember, we're going to be checking the age for rota, and if your area screens for S-SID which not all do, then we should normally have made every reasonable sort of effort to obtain that result, including asking the parents if they've had a latter.
00:29:58.324 -->
00:30:05.336However, if the parents were to decline the heel prick testing, we would still offer rota.
00:30:05.336 -->
00:30:11.969If they've moved from an area that doesn't test for estherd as part of the heel prick, then we'd still offer rota.
00:30:11.969 -->
00:30:19.168And if you work in an area that doesn't include estherd in the heel prick, then we would still offer that immunisation.
00:30:19.168 -->
00:30:25.467And then we can just continue down to the subsequent uh vaccinations boxes.
00:30:25.467 -->
00:30:28.019So it's yeah, so that one slightly simpler.
00:30:28.039 -->
00:30:55.409Just remembering if they're 16 weeks of age when they attend for their first immunizations, we can give the pcv at the same time, which is actually going back to fairly similar to what we did, sort of um, quite a few years ago, but we could do that because they're already at the age they should have been offered that we're going to get the protection in general principles get as much protection as we can in the fewest visits, remembering the rota age guidance there.
00:30:55.409 -->
00:31:03.104So from first up to the second birthday this is the one that threw me a bit, so I'll try and simplify it.
00:31:03.104 -->
00:31:16.402If they have had primaries before they turn one and then come late for one year IMS but before their second birthday we look at their date of birth.
00:31:16.402 -->
00:31:36.117However, if they didn't have any primaries before they turned one or they had at least one primary dose over the age of one, then they've met the requirement for Hib over one and so they don't need a meniteric.
00:31:36.117 -->
00:31:41.985They don't need the additional meniterics or six in one.
00:31:41.985 -->
00:31:51.826If they've had at least one dose over one year of age, you're still going to obviously be doing your three doses, but it's just it's.
00:31:51.826 -->
00:31:59.057It's just this bit here where it says about the um, the date of birth and what they've had, because we're remembering over one.
00:31:59.057 -->
00:32:00.461It's.
00:32:00.461 -->
00:32:03.390It's the Hib, not the Men's C that we're giving for now.
00:32:03.390 -->
00:32:15.837So if they've had at least one dose of Hib over the age of one, we don't need to give an additional Hib or we don't need to give an additional Minotrix or 6 in 1.
00:32:15.837 -->
00:32:25.770So if they're coming for their immunisations and they've not had any before, then we work it down.
00:32:25.770 -->
00:32:29.466We're going to look at the date of birth, follow that through.
00:32:29.466 -->
00:32:38.730If they've had one dose of Hib containing vaccine over one year of age, then they've met that Hib over one requirement.
00:32:40.596 -->
00:32:43.462All children need MenB over one year of age.
00:32:43.462 -->
00:32:50.206However, if they didn't have two doses in their first year of life, then they would need two doses in their second year of life.
00:32:50.206 -->
00:32:51.456So this is where I know.
00:32:51.456 -->
00:32:54.063I've just said sometimes it's helpful to cross off what they've had.
00:32:54.063 -->
00:33:07.824However, let's say if they'd had their first lot of primary immunisation, so they'd had that as normal and then they didn't come back again, we might be tempted to think they've had six in one.
00:33:07.824 -->
00:33:11.277They've had menb because they had their eight week ims.
00:33:11.277 -->
00:33:27.155However, if they've had oh, if they've had less than two doses of MenB before they were one, they'll need two doses of MenB before they turn two.
00:33:27.155 -->
00:33:32.797So that's where crossing out the MenB because they've already had it might be a little bit unhelpful.
00:33:32.797 -->
00:33:44.527So, yeah, it's just reading it all the way through, so and there it'll talk you through that and then continue reading down about your subsequent doses.
00:33:45.895 -->
00:33:48.161So read down the whole column.
00:33:48.161 -->
00:33:57.047And I would say, read down the whole column before you make any decision about any immunisation, before you give anything, read the whole column.
00:33:57.047 -->
00:34:03.447So then, second to tenth birthday, it gets a little bit simpler here.
00:34:03.447 -->
00:34:10.885But I would highlight that they may have had all their primaries but no one year IMS and pre-score booster.
00:34:10.885 -->
00:34:14.219So we may be tempted to initially think right, I'm going to cross off.
00:34:14.219 -->
00:34:19.401They had their eight week, they had their 12 week, they had their 16 week, oh, we just need MMR.
00:34:19.401 -->
00:34:25.515However, if we read all the way down, oh, we just need MMR.
00:34:25.515 -->
00:34:29.605However, if we read all the way down, they will still need a dose of Hib over the age of one.
00:34:29.605 -->
00:34:35.322If they've had, for example, their primaries and their one-year rims, then they'll have met that Hib requirement.
00:34:35.322 -->
00:34:38.194So it very much depends on what they had previously.
00:34:38.294 -->
00:35:00.084So just reading down the whole column, looking at what they've had and then making that decision, and then reading subsequent vaccinations and boosters, as the intervals required may need to be adjusted, and then obviously it gets a little bit simpler for over 10 years and onwards.
00:35:00.084 -->
00:35:05.090But, yeah, reading it through, also thinking about hepatitis B.
00:35:05.090 -->
00:35:23.070So if anybody is born before if any, sorry, if anybody is born from the 1st of August 2017 and they haven't had a hepatitis B containing vaccine, then we can offer monovalent as well.
00:35:23.070 -->
00:35:27.678So it's just just reading all through and taking time to check.
00:35:27.678 -->
00:35:32.868I'm sure we'll do, but, yeah, it it's a little bit more intricate.
00:35:33.009 -->
00:35:34.236The the new schedule.
00:35:34.236 -->
00:35:43.543Yeah, I would say if, if somebody presented in a busy clinic, I don't think there's anything wrong with saying I'm really sorry.
00:35:43.543 -->
00:35:46.341I need to make sure that we're going to be actually following the algorithm.
00:35:46.341 -->
00:35:53.980Let me work this through, and sometimes you might have to say you know we'll need to call you, call you back again and etc.
00:35:53.980 -->
00:35:55.765We want to be making sure that we're getting it right.
00:35:55.765 -->
00:36:06.608But really important reading through the whole column, because sometimes things further down here impact decisions up here.
00:36:09.775 -->
00:36:16.168Here's the resources, and so, as I say, the UK HSA slides go into a lot more, a lot more depth.
00:36:16.168 -->
00:36:24.534I hope this has been a little bit, you know, simplified, if you like to make it a little bit easier to work through.
00:36:24.534 -->
00:36:27.965Um, have a look at the, the resources and things.
00:36:27.965 -->
00:36:29.992I do think they are really helpful.
00:36:29.992 -->
00:36:32.478The calculator is great, but not for primaries.
00:36:32.478 -->
00:36:36.886Uh, you know we've got visual guides and aid memoirs etc.
00:36:36.886 -->
00:36:39.417So use the resources that are there.
00:36:39.417 -->
00:36:51.100Um, I do hope that it has been helpful in summarising all of the changes you know, helpful to sort of work it through step by step.
00:36:51.100 -->
00:36:55.168I hope it's been useful, thank you.
