The vaccinations timebomb – and what to do if you’ve missed them

Measles, the great scourge of infants during Victorian England, is back with a vengeance. It doesn’t seem so long ago that the World Health Organisation was declaring that the viral infection – which can spread to the brain and cause neurological complications as well as pneumonia – had been eliminated in England, thanks to the measles, mumps and rubella (MMR) vaccine.

But just seven years later, the UK Health Security Agency has declared a national incident, with rising measles cases in the West Midlands attributed to low vaccine uptake.

Coupled with some “anti-vax sentiment, which frustrates me,” says Dr Sarah Pitt, a microbiologist and infectious diseases expert at the University of Brighton, “it is why we’re seeing diseases like whooping cough, which has been controlled for 40 to 50 years, returning”.

For adults who may have missed a key childhood vaccine, it is never too late to get extra protection. As a result, experts are urging people to check their personal vaccine records by logging into the NHS app. 

“If an MMR dose was missed, an adult can still have it,” says Prof Helen Bedford at UCL Great Ormond Street Institute of Child Health. “Two doses are recommended, four weeks apart. There is no upper age limit for MMR vaccination, and I would still recommend vaccination – even if you suspect you might have already had measles (unless there is documented evidence). Vaccination will do no harm.”

According to London-based GP Dr Ziad Tukmachi, all of the following vaccines require a visit to the GP. Neither pharmacies nor health visitors can administer NHS vaccines. “It has to be a registered nurse,” he says. “So these vaccines are given at GP surgeries but some boosters are carried out by the school nurse too.” 

So what are the full list of jabs your children should have, and what should you do if they’ve missed some?

Common vaccines for babies and infants  

8 weeks to 1 year 

MMR, diphtheria, hepatitis B, haemophilus influenzae type b, polio, tetanus and whooping cough, rotavirus, MenB, Hib/MenC, pneumococcal vaccines

The MMR jab is typically administered in two doses, initially given around the child’s first birthday and then again at around three years and four months. 

Prof Helen Bedford says that if your child hasn’t had their necessary dose of the MMR vaccine, and measles is circulating in your area, it’s advisable to get them vaccinated as soon as possible because the jab can still protect them.

“If they’re exposed to measles, the MMR vaccine can be given within 72 hours to prevent infection,” she says.

But the MMR is just one of a whole series of vital childhood jabs. The so-called 6-in-1 vaccine should be given to babies at eight weeks, 12 weeks and 16 weeks, protecting them against diphtheria, hepatitis B, haemophilus influenzae type b, polio, tetanus and whooping cough.

This is then followed by a further booster against diphtheria, polio, tetanus and whooping cough called the 4-in-1 vaccine before children begin school.

Like the MMR jab, experts are worried about declining uptakes for the 6-in-1 and 4-in-1 jabs, with rates of both polio and whooping cough on the rise. 

Polio affects nerves in the spinal cord and brainstem, leading to paralysis of one or more limbs, while whooping cough can prove deadly to babies and infants, causing brain swelling and convulsions.

“Those who have not been fully vaccinated against polio are at risk of being paralysed and they also continue to facilitate transmission and the outbreaks that are occurring in the UK,” says Prof David Heymann of the London School of Hygiene & Tropical Medicine. “Vaccination against polio is therefore both a personal protective measure and an individual responsibility to protect the communities in which we live.”

Babies should also be vaccinated against rotavirus, a common cause of  diarrhoea and vomiting, at eight and 12 weeks, as well as the MenB jab at eight weeks, 16 weeks, and one year. The latter protects against meningococcal group B bacteria which can lead to meningitis and blood poisoning, known as sepsis. 

When they turn one, infants should also receive the Hib/MenC vaccine which protects against two common types of life-threatening bacterial infections. Both Haemophilus influenzae type b (Hib) and Meningococcal group C (MenC) bacteria can infect the protective membranes that surround the brain and spinal cord, resulting in permanent brain damage, as well as leading to sepsis. 

Because infants are particularly at risk of pneumonia, the NHS also recommends the pneumococcal vaccine; it protects against a particular bacterium called streptococcus pneumoniae which can cause serious lung infections in both the very young and old.

2 to 12 years old

Flu vaccine, Covid-19, chicken pox (optional)

Starting at the age of two, and continuing every year until they finish Year 11 of secondary school, children should receive the seasonal flu vaccine. This is at its most vital for preschoolers – according to the UK Health Security Agency, 6,000 children under five were hospitalised by flu during the winter of 2022/2023.

Flu vaccines are now easier for children to receive than ever before thanks to a new version which is administered as a nasal spray. According to Dr Hamid Merchant, a pharmacy researcher at the University of East London, these vaccines are now far more effective at preventing infections than their previous injectable equivalents.

As for Covid, NHS guidelines will change from 1 February 2024 and only children with severely impaired immune systems owing to an underlying chronic illness will be considered for vaccination.

“The risk of severe Covid-19 in children is very, very low in terms of hospital admissions, fatalities and long-term problems,” says Dr Shamez Ladhani, a paediatric infectious diseases specialist at St George’s Hospital, London. “You end up having to vaccinate a lot of children to have a little bit of improvement in terms of outcomes at a population level.”

Likewise, while an extremely effective vaccine is available for chickenpox – 90 per cent of those vaccinated will become immune after just a single dose – this isn’t routinely available on the NHS, unless a child is in regular contact with a vulnerable person. 

For example, exceptions are likely to be made if they have a parent undergoing chemotherapy for whom the virus could cause more severe problems.

This is because childhood complications from chickenpox are rare and almost all children develop immunity following infection.

12 to 18 years old

Tetanus, diphtheria and polio boosters, HPV

At 14, teenagers should receive a final booster jab against tetanus, diphtheria and polio called the Td/IPV vaccine, alongside the MenACWY vaccine which protects against four different strains of the meningococcal bacteria that cause meningitis and blood poisoning. The NHS website recommends that students heading to university should make sure they have received the latter because it protects against potentially deadly bouts of meningitis and septicaemia.

One of the most important new introductions in recent years has been the human papillomavirus (HPV) vaccine for all 12- to 13-year-old girls and boys, which vaccinates against nine strains of HPV that are known to be harmful.

HPV is the biggest cause of cervical cancer in women, with various strains linked to as many as 95 per cent of cases.

However, in the past decade, we have become increasingly aware that the HPV-16 strain is also responsible for around 90 per cent of head and neck cancers, with men being particularly affected, making this vaccine especially important.

“In 2017, the WHO formally recognised HPV as a distinct cause of a specific type of head and neck cancer – oropharyngeal squamous cell carcinomas, which impact the tonsils and the base of your tongue,” says Dr Elizabeth Marsh, an expert in HPV-positive cancers at the University of Derby. 

“Over half of the oropharyngeal squamous cell carcinomas in the UK are caused by HPV, and this rate continues to increase. In fact, oropharyngeal cancer in men is now more common than cervical cancer in women in both the UK and the US.”

18 to 80 years old

Flu, Covid-19, pneumococcal vaccine, RSV, shingles

Pregnant women are often identified as a key population, particularly for vaccines against flu and Covid-19. This is because the mother’s immune system is naturally weakened during the course of pregnancy to prevent her immune cells from mistakenly attacking the unborn baby, but this also makes her less able to fight off infections. 

Infectious disease experts are also trying to encourage pregnant women to have a booster jab against whooping cough because evidence suggests that the mother’s antibodies can be passed onto the foetus, providing it with protection even after birth, until the first jab at eight weeks old.

As we age, other vaccines become increasingly important as our immunity wanes. The NHS now recommends the pneumococcal vaccine to protect against bacterial pneumonia and the seasonal flu vaccine for all over-65s. 

The shingles vaccination is available to all over-65s and given in two doses, between six and 12 months apart. From age 50 for the severely immunosuppressed.

75 and older

RSV

A new annual vaccination campaign for respiratory syncytial virus (RSV) – an infection that kills 33,000 over-65s every year – is expected to begin this autumn, starting in those aged 75 and older. 

“RSV is a very substantial cause of premature deaths among the elderly in the UK, especially as it seems to exacerbate chronic lung illness,” says Prof Peter Openshaw at Imperial College London. “There’s a prospect that vaccines could result in stabilisation of those chronic lung problems.”

Can some people not have vaccines?

According to the NHS, there are only a small fraction of people who are not eligible for vaccines, either due to allergic reactions or a compromised immune system.

Prof Andrew Ustianowski, an infectious diseases consultant in Manchester, says there remains an ongoing need to develop alternative solutions for these individuals, such as artificial injected antibodies which can simulate the immunity they would get from a vaccine.

“There are people who are unable to take a vaccine,” he says. “There are people undergoing chemotherapy, people who’ve had a transplant, and a much wider group of people who have rheumatological or even gastrointestinal conditions which impair their immune system, and that affects the efficacy of a vaccine.”