Vaccinations at 12 and 13 months of age

Objectives

The policy simplifies routine childhood immunisation at 12 to 13 months by combining Haemophilus influenzae type b/meningococcal C (Hib/MenC), measles, mumps and rubella (MMR), and pneumococcal conjugate vaccine 13 (PCV13) at a single visit after the child’s first birthday.[1][2]The intended outcomes are to reduce the number of appointments and associated distress for children and parents, while maintaining vaccine safety and potentially improving uptake.[1][3][2]

• Administer Hib/MenC, MMR and PCV13 together at one routine appointment between 12 and 13 months of age.[1][2]
• Avoid administering these booster vaccinations before 12 full calendar months, rather than treating 48 weeks as equivalent to 12 months.[2]
• Reduce avoidable parent and child visits by replacing separate fourth and fifth immunisation appointments with a combined visit.[2][4]
• Maintain a standard simplified schedule across practices rather than routinely offering parents a choice of schedules, as research indicated that choice could create additional uncertainty and questions.[3]
• Support confidence in the combined appointment through evidence reviewed by the Joint Committee on Vaccination and Immunisation that simultaneous administration is safe and does not adversely affect vaccine immune responses.[1]

Implementation

Delivery is centred on universal provision of the three vaccines in one primary-care appointment for eligible children, supported by clear clinical administration procedures, accurate scheduling and recording systems, parent communication, vaccine supply management, and local service-arrangement updates.[1][2][4]Implementation involves Primary Care Trust Directors of Public Health, immunisation co-ordinators, general practitioners, lead nurses, pharmacists, Child Health Departments, and other National Health Service public-health, medical and nursing leads.[1][2]

• Offer all three vaccines at the same appointment in every practice for children attending soon after their first birthday.[1][2]
• Administer injections in separate limbs where possible, or at least 2.5 centimetres apart when using the same limb, and do not mix vaccines in a single syringe.[2]
• Provide MMR and PCV13 first if parents decline three vaccinations at one visit, then arrange Hib/MenC at a subsequent appointment.[2]
• Inform parents or people with parental responsibility about all three vaccines, obtain consent, and allow sufficient opportunity to discuss concerns before vaccination.[4]
• Order all three vaccines through the ImmForm website for appointments after the first birthday, while maintaining only two to four weeks of local vaccine stock.[2]
• Review general practice and Child Health Information System scheduling processes to prevent invitations before 12 full calendar months.[2]
• Record and code each of the three vaccinations accurately in electronic patient records and Child Health Department systems.[2]
• Amend local enhanced service arrangements where required because the formerly separate fourth and fifth immunisation visits are combined.[4]
• Update routine childhood immunisation schedule materials, relevant parent leaflets, and Green Book chapters, with specified chapter revisions planned by the end of November 2010.[2][4]
• Assess the effect on uptake as Primary Care Trust data accumulate, recognising that evaluation may take time and may be difficult in areas where combined appointments were already in use.[3][2]

Monitoring & Evaluation

Monitoring focuses on whether combining Haemophilus influenzae type b/meningococcal C (Hib/MenC), measles, mumps and rubella (MMR), and pneumococcal conjugate vaccine (PCV13) at one appointment between 12 and 13 months improves vaccination uptake. The change was informed by Joint Committee on Vaccination and Immunisation safety and immune-response evidence, together with qualitative research involving parents and health professionals in July 2010.[1][3]

• Assess uptake effects as data accumulate from Primary Care Trusts, while recognising that evaluation may take time and may be harder in areas where practices had already introduced a combined visit.[3][2]
• Record and code each of the three vaccinations accurately in general practitioner electronic patient records and Child Health Department systems.[2]
• Ensure child-health and general practitioner scheduling systems invite, record and monitor vaccination only from 12 full calendar months of age, rather than incorrectly treating 12 months as 48 weeks.[2]
• Maintain the combined visit as the standard arrangement across practices, rather than presenting two alternative schedules to parents, supporting consistent delivery and interpretation of uptake data.[1][3]

The available material does not set formal performance indicators, numerical uptake targets, reporting intervals, named reporting recipients, surveillance protocols, audit arrangements, or explicit accountability sanctions.[3][2]

Costing & Financing

Funding and service-review arrangements for the childhood immunisation programme remain unchanged following the move to a combined appointment.[4]

• Amend local enhanced service arrangements where applicable because the former fourth and fifth immunisation visits are combined into one appointment.[4]
• Recognise that some Primary Care Trusts may have local enhanced service agreements that provide an additional payment for completing the fifth visit; the source does not give the payment amount.[4]
• Plan vaccine ordering so that general practitioner practices obtain all three vaccines for appointments soon after the first birthday and hold approximately two to four weeks of local stock, although no associated cost is specified.[2]
• Update scheduling systems, information materials and local service arrangements as part of implementation, but no budget allocation, funding source, funding gap, resource estimate, monetary saving, or economic assumption is provided.[2][4]