UK Paediatric Immunisation Schedule 2026: A Complete Guide

The Major Change: MMRV (Chickenpox) Vaccine

The introduction of the MMRV vaccine is the headline news of the 2026 schedule. It replaces the standalone MMR vaccine for routine appointments.

Why the Change?

Historically, the UK did not vaccinate against Chickenpox (Varicella Zoster) because of concerns about shifting the disease to older age groups (where it is more severe) and potentially increasing Shingles rates in the elderly (due to a lack of natural boosting).

However, updated JCVI modelling showed that:

1. Complications are significant: Chickenpox is a leading cause of severe bacterial superinfection (Group A Strep) in children. You must be able to differentiate these presentations from vaccine reactions—see our guide on Common Paediatric Rashes for high-quality clinical images.

2. Two-dose strategy works: By giving doses at 12 months and 18 months, herd immunity is achieved rapidly, protecting those who cannot be vaccinated.

3. School attendance: Reducing chickenpox outbreaks significantly reduces school absences and parental time off work.

The “Cohort” Confusion

For the UKMLA, you must know which child gets which vaccine.

• Born on/after 1st Jan 2025: Will receive the full new schedule (MMRV at 12m and 18m).

• Born before 2025: These children are currently in a “Catch-up Campaign” phase. If they present to your GP practice aged 3-6 years old having missed Chickenpox immunity, they are eligible for a catch-up dose, often given alongside the pre-school booster.

The New 18-Month Appointment

Prior to 2026, there was a long gap between the “1-year immunisations” and the “Pre-school booster” at 3 years and 4 months. This gap often led to a drop-off in compliance.

The new 18-Month Check serves three purposes:

1. MMRV Dose 2: Completes protection against Measles and Chickenpox early, before the child enters nursery/preschool mixing circles.

2. Hexavalent (6-in-1) Dose 4: This acts as a booster for Hib (Haemophilus influenzae type b) and Hepatitis B.

3. Developmental Opportunity: It provides a formal touchpoint for Health Visitors or GPs to assess Paediatrics Essentials (e.g., walking, early speech) which was previously unstructured.

Note: Because the Hexavalent booster is now given at 18 months, the old Hib/MenC (Menitorix) vaccine at 12 months has been discontinued. Meningitis C protection is now primarily relied upon via the adolescent Men ACWY vaccine and herd immunity.

Changes You Might Have Missed (July 2025 Updates)

While the MMRV is the 2026 headline, two subtle timing changes from late 2025 are still tripping up candidates.

MenB (Meningococcal B)

• Old Schedule: 8 weeks, 16 weeks, 1 year.

• New Schedule: 8 weeks, 12 weeks, 1 year.

• Reasoning: Moving the second dose to 12 weeks provides earlier protection during the peak risk window for infants.

PCV (Pneumococcal)

• Old Schedule: 12 weeks, 1 year.

• New Schedule: 16 weeks, 1 year.

• Reasoning: This spacing allows for co-administration with other vaccines at 16 weeks and reduces the number of separate appointment visits required (improving attendance).

Special Risk Groups

While the routine schedule covers 99% of children, the UKMLA tests the exceptions.

Hepatitis B (Selective Pathway)

Infants born to Hepatitis B positive mothers (HBsAg positive) are high risk for vertical transmission and chronic carriage. They follow a specific, intensified pathway outlined in General Practice Essentials.

• Birth: Monovalent HepB vaccine + HBIG (Immunoglobulin) (if mother is highly infectious/e-antigen positive).

• 4 Weeks: Monovalent HepB vaccine.

• 8 Weeks: Routine 6-in-1 (contains HepB).

• 12 Weeks: Routine 6-in-1.

• 16 Weeks: Routine 6-in-1.

• 1 Year: Blood test for HBsAg (to check for infection).

• 18 Months: Routine 6-in-1 booster.

BCG (Tuberculosis)

The UK does not vaccinate everyone for TB. It is risk-based.

• Indication: Infants born in areas of the UK with TB incidence >40 per 100,000 OR infants with a parent/grandparent born in a high-prevalence country.

• Timing: Usually at birth (or as soon as possible).

Contraindications & Cautions

Understanding when not to vaccinate is a key skill covered in our Anaphylaxis Management guide.

Anaphylaxis

The only absolute contraindication to a vaccine is a confirmed anaphylactic reaction to a previous dose of that vaccine or one of its components (e.g., Neomycin or Gelatine).

Egg Allergy

• MMR/MMRV: Safe. The virus is grown on fibroblast cells, not egg. Even if there is a trace, it is safe for children with egg allergy (including anaphylaxis) to be vaccinated in primary care.

• Influenza (Flu): Most injectables are egg-free. The nasal spray has trace egg protein but is safe for those with mild allergy. Those with egg anaphylaxis should receive an egg-free injectable.

Immunosuppression

Live Vaccines contain weakened virus and pose a risk to severely immunosuppressed children (e.g., SCID, Chemotherapy, High-dose steroids).

• The Live Vaccines in 2026:

  1. Rotavirus (Oral).

  2. MMRV (Injectable).

  3. BCG (Intradermal).

  4. Flu Nasal Spray.

• Action: Do not administer these without specialist advice. Inactivated vaccines (6-in-1, MenB) are safe but may be less effective.

Clinical Scenarios: Putting it into Practice

Scenario 1: The “Anti-Vax” Discussion

Parent: “I’ve heard the MMRV overloads the immune system because it’s too many viruses at once.” Doctor’s Response: You must acknowledge the concern but correct the science. Utilizing principles from Informed Consent Guidelines is crucial here.

• Fact: A baby’s immune system fights thousands of antigens daily (from crawling on the floor, eating, breathing).

• Fact: The vaccines contain only a tiny handful of protein markers (antigens).

• Fact: Combined vaccines (like MMRV) reduce the number of injections (distress) and provide protection sooner. Delaying “to split them up” leaves the child vulnerable to Measles and Chickenpox during the delay.

Scenario 2: The Immigrant Child

Patient: A 4-year-old arrives from a country with a different schedule. They have no documentation. Action: The UKHSA rule is: “If in doubt, immunise.”

• You cannot assume they are protected.

• Start the Vaccination of Individuals with Uncertain or Incomplete Immunisation Status algorithm.

• For a 4-year-old in 2026: They need a dose of MMRV, a dose of the Pre-school booster (4-in-1), and likely catch-up doses of MenB depending on the specific algorithm.

Practice Exercise: Test Your Knowledge

Question 1: A 4-month-old baby presents for their routine immunisations. Which vaccines are they due to receive today under the 2026 schedule?

A) 6-in-1 + PCV + MenB

B) 6-in-1 + Rotavirus + MenB

C) 6-in-1 + PCV

D) 6-in-1 + Rotavirus

E) MMRV + MenB

Correct Answer: C (6-in-1 + PCV). At 16 weeks (4 months), the schedule is the 3rd dose of the 6-in-1 and the 1st dose of PCV. Note that Rotavirus is given at 8 and 12 weeks only (it is contraindicated after 24 weeks due to intussusception risk).

Question 2: A mother brings her 13-month-old son. He received his 1-year immunisations last week (MMRV, MenB, PCV). She is worried he has a fever of 38.5°C today and a mild rash. What is the most appropriate advice?

A) Urgent referral to Paediatrics for suspected Meningitis.

B) Reassurance and Paracetamol; this is a common reaction to the MMRV component.

C) Reassurance; this is a common reaction to the MenB component.

D) Prescribe oral antibiotics for suspected otitis media.

E) Report as a Yellow Card adverse event immediately.

Correct Answer: B. While MenB causes fever within 24-48 hours, the MMR/MMRV vaccine typically causes a fever and/or a mild measles-like rash 6 to 10 days after administration. This fits the timeline perfectly (1 week later).