• Plan to achieve immunity to diphtheria, tetanus, pertussis, (DTaP), polio, Haemophilus (Hib), meningococcus B, pneumococcus, rotavirus and hepatitis B within 4 months of birth (see also BCG immunisation and Hepatitis B and C guidelines)
• See Department of Health Immunisation against Infectious Diseases ‘Green Book’ for national policy and for current schedule seehttps://www.gov.uk/government/collections/immunisation

• Cardiorespiratory events (apnoeas, bradycardia and desaturations) are not contraindications to immunisation, but continue to monitor for a further 72 hr following immunisation
• See Precautions with rotavirus vaccine 

Consent

• Inform parents of process, benefits and risks
• For further information refer parents to www.nhs.uk/conditions/vaccinations
• Offer parents opportunity to ask questions
• Informed consent (can be written or oral) must be obtained and recorded in notes at time of each immunisation
• Inform local Child Health Information System (CHIS)

Prescription

Use immunisation listed in ‘Green Book’ – see Routine immunisations for all babies 

• Keep strictly to schedule to avoid delay
• Order vaccines in advance unless held as stock on NNU
• Prescribe on treatment sheet

Administration

• DTaP/IPV/Hib/HepB (Infanrix hexa®) is a 6-in-1 preparation
• Administer by IM injection into thigh; give ≥2.5 cm away from other vaccination sites
• Dose for all primary immunisations (DTaP/IPV/Hib/HepB), meningococcal B, pneumococcal) is 0.5 mL
• Give meningococcal B (Bexsero®) and pneumococcal (Prevenar 13®) vaccine into separate injection sites in other thigh
• Rotavirus vaccine must not be injected and preferably not given via an NGT 
  • assess ability to tolerate oral administration

• After immunisation, document the following in case notes as well as in Child Health Record (Red Book):
  • consent gained from parents
  • vaccine given and reasons for any omissions
  • site of injection(s) in case of reactions
  • batch number of product(s)
  • expiry date of product(s)
  • legible signature and GMC number of doctor administering immunisations
  • adverse reactions
• Sign treatment sheet
• Complete immunisation form in BadgerNet system. Document all information on discharge summary and medical case notes, including recommendations for future immunisations and need for any special vaccinations, e.g. influenza, palivizumab, etc.
• Notify CHIS

• Babies born <28 weeks may have an impaired immune response. Check functional antibodies 1 month after booster at aged 1 yr, if needed
• Babies <28 weeks’ gestation at birth, who are in hospital – respiratory monitoring for 48–72 hr when given first routine immunisations 
• If baby has apnoea, bradycardias or desaturations after first routine immunisations, second immunisation should ideally be given in hospital with respiratory monitoring for 48–72 hr

• Local:
  • extensive area of redness or swelling
• General:
  • fever >39.5°C within 48 hr
  • anaphylaxis
  • bronchospasm
  • laryngeal oedema
  • generalised collapse
  • episodes of severe apnoea
  • diarrhoea
  • irritability
  • vomiting
  • flatulence
  • loss of appetite
  • regurgitation

Specific notes for rotavirus vaccination

• Do not give Rotarix® to babies aged <6 weeks 
  • minimum age for first dose of Rotarix® is 6⁺⁰ weeks
  • maximum age for first dose is 14⁺⁶ weeks
• Do not give first dose of Rotarix® to babies aged ≥15⁺⁰ weeks. Babies who have received their first dose of vaccine aged <15⁺⁰ weeks should receive their second dose of Rotarix® after a minimum interval of 4 weeks and by aged 23⁺⁶ weeks 
  Do not give Rotarix® vaccine to babies aged ≥24⁺⁰ weeks 

Precautions with rotavirus vaccination

• Postpone administration of rotavirus vaccine in babies suffering from: 
  • acute severe febrile illness
  • acute diarrhoea or vomiting
  • first dose must be given aged <15 weeks 
• Do not administer Rotarix® to babies with: 
  • confirmed anaphylactic reaction to a previous dose of rotavirus vaccine
  • confirmed anaphylactic reaction to any components of the vaccine
  • history of intussusception
  • aged ≥24⁺⁰ weeks 
  • severe combined immunodeficiency disorder (SCID)
  • malformation of the gastrointestinal tract that could predispose them to intussusception
  • rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency

Influenza (in autumn and winter only)

Indications

• Chronic lung disease (on, or recently had, oxygen) 
• Congenital heart disease, renal, liver or neurological disease
• Immunodeficiency

Recommendations

• Recommend vaccination to close family members of these babies
• Give babies aged >6 months–2 yr, 2 doses 4–6 weeks apart, IM injection
• Note: intranasal flu vaccine is now routinely recommended for children aged ≥2 yr

Palivizumab

See Palivizumab guideline

BCG

See BCG immunisation guideline

Hepatitis B

See Hepatitis B and C guideline for babies born to mothers with these infections

HIV

• See Human immunodeficiency (HIV) guideline
• Babies who are HIV infected, or HIV exposed (born to HIV positive mother) and status not yet known:
  • routine immunisations including rotavirus vaccine not contraindicated
  • if BCG indicated see BCG immunisation guideline. If baby deemed to be low risk or very low risk of HIV transmission, do not delay BCG immunisation

Routine immunisation schedule aged ≤16 weeks

See https://www.gov.uk/government/publications/the-complete-routine-immunisation-schedule