Guidance

Immunisations at one year of age

Updated 26 July 2023

Applies to England

Immunisations your baby will have at one year of age

Your baby will have 4 injections at their one-year vaccination visit including:

1.  MenB (meningococcal group B) booster immunisation

2.  Hib/MenC immunisation against:

• haemophilus influenzae type b (Hib)
• meningococcal group C disease (MenC)

3.  PCV13 (pneumococcal conjugate vaccine) booster against pneumococcal disease caused by some types of pneumococcal bacteria

4.  Their first MMR immunisation against:

• measles
• mumps
• rubella

Remember to bring your child’s Redbook of immunisation with you to each appointment. Copies of these booklets are available from your clinic or doctor’s surgery.

Protecting against Hib, meningococcal groups B and C disease

Hib

Hib is an infection that can lead to a number of major illnesses such as meningitis (inflammation of the lining of the brain), septicaemia (blood poisoning) and pneumonia, especially in young children.

Meningococcal disease

Meningococcal disease is a serious infection that can also cause meningitis and septicaemia in children and young people.

Group B meningococcal bacteria (MenB) are currently responsible for most cases of meningococcal disease in the UK, while meningococcal group C (MenC) disease is now uncommon because most young children and teenagers are routinely vaccinated against MenC.

Which vaccines will be used?

Your child will have a dose of a combined Hib/MenC vaccine as well as a booster dose of a MenB vaccine. These vaccines will be given in the muscle of the thigh or upper arm.

The Hib/MenC vaccine is called Menitorix, further information is available in the Patient Information Leaflet.

The MenB vaccine is called Bexsero, further information is available in the the Patient Information Leaflet.

Why your child will need booster immunisations

Booster immunisations are given to increase the protection already given by the immunisations your baby has had earlier. The protection offered by the infant vaccinations can wear off after some time. A booster dose extends the period of protection into later life.

Side effects of the Hib/MenC and MenB vaccines

Your child may have redness, swelling or tenderness where they had the injection. About half the children who have the vaccine may become irritable, and some get a mild fever. You can get more information on this from your GP, practice nurse or health visitor when you take your child to have their vaccines.

Protecting against pneumococcal disease

Pneumococcal disease

Pneumococcal disease is one of the most common causes of bacterial meningitis in children but it also causes septicaemia, pneumonia, ear infections (otitis media) and other serious illnesses. There are more than 90 different types of pneumococcal bacteria.

Which vaccine will be used?

The vaccine used is a booster dose of PCV13 (pneumococcal conjugate vaccine) which protects against 13 different pneumococcal types that most commonly cause pneumococcal disease in children. This vaccine will be given in the muscle of the thigh or upper arm at the same visit as the Hib/MenC and MenB vaccines.

The PCV vaccine is called Prevenar 13, further information is available in the Patient Information Leaflet.

Side effects of the PCV vaccine

Out of 10 babies immunised, 1 or 2 may get swelling, redness or tenderness at the injection site or get a mild fever.

Protecting against measles, mumps and rubella (MMR)

Measles

Measles is caused by a very infectious virus. Nearly everyone who catches it will have a high fever, a rash and generally be unwell.

The complications of measles include chest infections, fits (seizures), encephalitis (infection of the brain), and brain damage. In very serious cases, measles can kill.

Mumps

Mumps is caused by a virus which can lead to fever, headache, and painful, swollen glands in the face, neck and jaw. It can result in permanent deafness, viral meningitis and encephalitis (inflammation and swelling of the brain).

Rubella

Rubella (German measles) is a disease caused by a virus. In children it is usually mild and can go unnoticed. But, rubella in pregnancy is very serious for unborn babies. It can seriously damage their sight, hearing, heart and brain. This condition is called congenital rubella syndrome (CRS).

The MMR vaccine

It contains weakened versions of live measles, mumps and rubella viruses. Because the viruses are weakened, people who have had the vaccine cannot infect other people. In the UK we have 2 MMR vaccines. Both work very well, one contains porcine gelatine and the other doesn’t. If you want your child to have the porcine gelatine-free vaccine, discuss it with your practice nurse or GP.

You can view the MMR vaccine Patient Information Leaflets at:

• Priorix
• MMRVAXPRO

The MMR vaccine is the safest way to protect your child against measles, mumps and rubella.

How and when the vaccine is given

The vaccine is injected into the muscle of the thigh or upper arm. It is given at one year of age after the immunity the baby got from their mother fades. A second dose of the vaccine should be given again before your child starts school at around 3 years and 4 months of age.

Effectiveness of the MMR vaccine

MMR vaccine has been responsible for almost wiping out these 3 diseases in young children since it was introduced in the UK in 1988.

Side effects of the MMR vaccine

The 3 different viruses in the vaccine act at different times and may produce the following side effects after the first dose:

• 6 to 10 days after immunisation, as the measles part of the vaccine starts to work, about 1 in 10 children may develop a fever and some may develop a mild measles-like rash and go off their food

• about 1 in every 1,000 immunised children may have a fit caused by a fever – this is called a ‘febrile convulsion’; however, children who are not immunised and get measles are 3 times more likely to have a fit

• about 3 weeks after MMR vaccination, as the mumps part of the vaccine starts to work, some children may rarely get mumps-like symptoms (fever and swollen glands)

• very rarely, children may get a rash of small bruise-like spots in the 6 weeks after the vaccination, usually caused by the measles or rubella parts of the vaccine – if you see spots like these, take your child to the doctor to be checked; your doctor will tell you how to deal with the rash and how to protect your child in the future

• fewer than one in a million children may develop encephalitis (inflammation and swelling of the brain) after the MMR vaccine. However, if a child catches measles, the chance of developing encephalitis is between 1 in 200 and 1 in 5,000

If your baby is allergic to eggs

The MMR vaccine can safely be given to children who have had a severe allergy (anaphylactic reaction) to egg. If you have any concerns, talk to your health visitor, practice nurse or doctor.

The MMR vaccine and gelatine

In the UK, we have 2 MMR vaccines which work very well. One of them contains gelatine and the other one doesn’t. If you would prefer to have the vaccine that does not contain porcine gelatine, talk to your practice nurse or GP. See the MMR vaccine Patient Information Leaflets

Watch out for meningitis and septicaemia

Both meningitis and septicaemia are very serious. It is important that you recognise the signs and symptoms and know what to do if you see them.

Early symptoms of meningitis and septicaemia may be similar to a cold or flu (fever, vomiting, irritability and restlessness).

However, individuals with meningitis or septicaemia can become seriously ill within hours, so it is important to know the signs and symptoms of these conditions.

Meningitis

Meningitis is an infection of the lining of the brain. Meningitis can be caused by several types of bacteria or viruses.

Infection with meningococcal bacteria can cause meningitis, septicaemia (blood poisoning), pericarditis (inflammation of the lining of the sac that contains the heart) and arthritis (swelling of the joints).

In babies, the main symptoms of meningitis may include:

• a high-pitched, moaning cry
• irritable when picked up
• a bulging fontanelle
• drowsy and less responsive – being difficult to wake
• floppy and listless
• stiff with jerky movements (convulsions or fits)
• refusing feeds, vomiting
• skin that is pale, blotchy or turning blue
• a fever

Septicaemia

Septicaemia is a very serious condition when the blood stream is infected. The signs of cold hands and feet, pale skin, vomiting and being very sleepy or difficult to wake can come on quickly. If you suspect septicaemia, get help urgently.

In babies, the main symptoms of septicaemia may include:

• rapid or unusual patterns of breathing
• skin that is pale, blotchy or turning blue
• fever with cold hands and feet
• shivering
• vomiting and refusing feeds
• red or purple spots that do not fade under pressure (do the glass test explained below) ^{[footnote 1]}
• pain or irritability from muscle aches or severe limb or joint pain
• floppiness
• severe sleepiness

It is important to remember that not everyone will develop all the symptoms listed. If an individual develops some of the symptoms, especially red or purple spots, get medical help urgently. If you can’t get in touch with your doctor, or are still worried after getting advice, trust your instincts and take your child to the emergency department of your nearest hospital.

The ‘glass test’

Press the side of a clear drinking glass firmly against the rash so you can see if the rash fades and loses colour under pressure. If it doesn’t change colour, contact your doctor immediately.

Further information

These charities provide meningitis and septicaemia information, advice and support:

• Meningitis Research Foundation, free helpline 0808 800 3344 9am to 10pm weekdays, 10am to 8pm weekends and holidays
• Meningitis Now, 24 hour helpline 0808 801 0388

See vaccinations on NHS.UK for more information.

You can also ask your doctor, practice nurse or health visitor for advice, or call the NHS on 111.

Reporting side effects

Parents and carers can report suspected side effects of vaccines and medicines through the Yellow Card Scheme. This can be done online or by calling the Yellow Card hotline on 0800 731 6789 or by downloading the Yellow Card app.

The routine immunisation schedule

The complete immunisation schedule from February 2022 is available to view or download and includes:

• routine immunisation schedule
• selective immunisation programmes
• additional vaccines for individuals with underlying medical conditions

1. On dark skin, check inside the eyelids or roof of the mouth where the spots may be more visible. ↩