There are other vaccines that are equally beneficial but are not currently included in the UK routine schedule. Some are already included in routine immunisation in other countries. These vaccines are available in the UK on request and therefore it is worth discussing with your doctor. The information underneath is to help you with making an informed decision.

DTaP/IPV/Hib (diphtheria, tetanus, whooping cough, Polio, Haemophilus influenza type B)
MenC vaccine (meningococcal group C)
MMR (mumps, measles and rubella)

1. BCG vaccine

The BCG is administered to protect infants and children against tuberculosis. The vaccine is given on the left side of the arm by a special technique just under the skin and takes 6-12 weeks to heal leaving a permanent scar at the site of injection. It is therefore important that BCG vaccine is given by operators skilled in the technique. BCG should be given at the insertion of the deltoid muscle onto humerus, keloid formation more likely with sites higher on arm; tip of shoulder should be avoided.

BCG is recommended for the following group of children:

• all infants(0-12 months) living in areas where the incidence of tuberculosis is greater than 40 per 100.000;
• infants with a parents or grandparent born in a country with an incidence of tuberculosis greater than 40 per 100.000;
• previously unvaccinated new immigrants from countries with a high incidence of tuberculosis;
• contacts of those with active respiratory tuberculosis;
• children staying for more than 1 month in countries with high risk( Asia, Africa, central and South America (should preferably be given three months or more before departure);
• newborn babies, infants or children where immunisation is requested.

BCG can be given simultaneously with other live vaccines and when given to infants, there is no need to delay the primary immunisations. But if not given at the same time, an interval of 4 weeks should normally be allowed between them. No further vaccination should be given in the arm used for BCG vaccination for at least 3 months because of the risk of regional lymphadenitis (infection of the lymph nodes).

2. Rota virus vaccine

Rota virus infection is the most important cause of severe dehydration and gastroenteritis in infants and young children worldwide. Rotavirus gastroenteritis (RVGE) is most common and severe in children aged 6-24 months, and virtually all children have been infected by the virus by three years of age. An estimated 72,000-77,000 hospitalisation for community acquired RV disease occurs annually in the 23 million children under five living in the European Union.

The most common clinical presentation of the RV disease is sudden onset of vomiting, fever and dehydration accompanied by 3-8 days of watery diarrhoea. Usually oral rehydration therapy is less successful.

Rota virus vaccine is given orally, in two doses. The first oral dose may be administered from the age of 6 weeks, with an interval of at least 4 weeks between doses. This allows the completion of the course before the age of peak prevalence. The Rota virus vaccine is excreted in the stool and may be transmitted to close contacts; the vaccine should be used with caution in those with immune compromised close contacts. Carers of recently vaccinated baby should be advised to wash their hands after changing the baby’s nappies.

3. Varicella- zoster vaccine (chicken pox vaccine)

Chicken pox is a common and highly infectious disease caused by the varicella –zoster virus. In general it is a benign condition but could be more serious disease especially when introduced in a community where it is not endemic and in young infants and adults.

The vaccine is given by injection to children over the age of 1 year with a second dose 4-6 weeks later. A rash may develop within 4-6 weeks following the 1^st or 2^nd injection.

Rarely the virus has been transmitted from the vaccinated child to close contacts. Therefore contact is avoided if rash developed following the vaccination by the varicella susceptible pregnant females and the immune compromised.

The vaccine is not currently included in the routine vaccination in the UK but given routinely in the USA.

4. Seasonal Influenza vaccine

The recommended strains are grown in chick embryos, therefore contraindicated in those hypersensitive to eggs.

Prophylaxis of Influenza, especially in children 6-35months who run an increased risk of associated complications, could be given to pregnant females.

Annual immunisation is strongly recommended for children including infants that were preterm or low birth weight aged over 6 months with the following conditions:

• Children aged 6-35 months should receive one 0.25ml dose.
• Chronic respiratory condition including asthma;
• Chronic heart disease;
• Chronic renal disease;
• Diabetes mellitus
• Dose should be administered IM or deep SC
• Immunosuppression
• Hiv infection

Children who have not been previously vaccinated should receive a second dose of vaccine after an interval of at least 4 weeks

Contraindications Flu Vaccine:

Hypersensitivity to the active substances

• Eggs
• Chicken protein
• Neomycin
• Formaldehyde
• Octoxinol 9

5. Hepatitis B vaccine

Hepatitis B vaccine is part of routine immunisation in many countries

• In the UK, high risk groups include:
• Parental drug abusers;
• Adolescents who are at risk from their sexual behaviour;
• Close family contacts of a case or carrier;
• Infants born to mothers who are hepatitis B antigen positive.
• Children with haemophilia, those receiving regular blood transfusion or blood products and carers responsible for administering such products;
• Children with chronic renal failure and on haemodialysis
• Patients of day care or residential accommodation
• Children in custodial institutions;
• Children travelling to areas of high prevalence;
• Families adopting children from countries with a high prevalence of Hepatitis B

6. Hepatitis A vaccine

It has worldwide distribution and causes morbidity 15-50 days from the exposure and may have a fluctuating course with symptoms recurring over few months.

Is given to children over from one year old by intra muscular injection. A booster dose is usually given 6-12 months after the initial dose.

Recommended for

• children travelling to high risk areas( high risk areas outside Northern and Western Europe; North America; Japan; Australia and New Zealand);
• adolescents who are at risk due to their sexual behaviour;
• people travelling to areas with poor sanitation
• residents of homes for those with severe learning difficulties
• children with haemophilia treated with factor VIII or Factor IX concentrate;
• children with liver disease;
• children who have been infected with hepatitis B or hepatitis C;
• parental drug abuser

7. Typhoid vaccine

Typhoid vaccine is advised for children travelling to:

• Areas where typhoid is endemic, especially if staying with or visiting local people
• Endemic areas where frequent or prolonged exposure to poor sanitation and poor food hygiene is likely
• Children under 2 years may respond sub optimally to the vaccine, but children aged between 1-2 years should be immunised if the risk of typhoid fever is considered high.( Immunisation not recommended for infants under 12 months) booster doses at are needed every 3 years on continual exposure.
• Oral typhoid vaccine available in capsules, one capsule on alternate days for a total of 3 doses, provides protection 7-10 days after the last dose.
• Children over 2 years by intramuscular injection at least two weeks before exposure, booster doses every 3 years on continued exposure

8. Human papiloma virus vaccine

Cervarix (bivalent): Licenced for use in females for the prevention of cervical cancer and other pre-cancerous lesions caused by human papilloma virus types 16 and 18.

Gardasil ( quadrivalent): Licenced for use in females for the prevention of cervical cancer, genital warts and other pre-cancerous lesions caused by human papilloma virus types 6, 11, 16 and 18.

Most effective if given before sexual activity starts. 1^st dose given to female aged 12-13 years, 2^nd and 3^rd doses given 1-2 and 6 months after the 1^st dose. All three injections should be given within 12 months period.