Immunisation is the safest and most effective way to protect babies and children from disease. Health practitioners and early years professionals have the responsibility of explaining this to parents and carers as well talking to and listening to parents about their concerns.
Emphasis should be on when and why immunisation is recommended, how safety and risk are understood and what to do if immunisations are missed.
Immunisation and screening and inequalities in 0-3s
Immunisations and screening tests for health problems help reduce health inequalities by preventing infections and securing appropriate early treatments and other supports.
Immunisation rates are lower among children living in deprivation and some other groups experiencing inequalities.
Quick links:
- What are health inequalities?
- Policy context
- What are the universal screening tests and routine immunisations for 0-3s?
- When are immunisations given and what are they?
- Routine childhood immunisation programme poster
- How do inequalities impact on childhood immunisations and screening in Scotland?
- Identifying those at risk
What are health inequalities?
The WHO defines health inequalities as "differences in health status or in the distribution of health determinants between different population groups."
For a fuller discussion, please see Inequalities in the Early Years.
Policy context
Activity in this area is consistent with commitments and priorities detailed in The Early Years Framework and the National Parenting Strategy, Equally Well, Achieving our Potential, a range of NHS Scotland's Quality Indicators, and is relevant to Scotland's national practice model for child-centred services - Getting it Right for Every Child (all external links).
What are the universal screening tests and routine immunisations for 0-3s?
Newborn screening tests and routine immunisations are organised centrally by NHS Scotland.
All newborns are given:
- a routine examination for obvious physical abnormalities within 72 hours of birth
- blood spot screening tests for a range of diseases and congenital (inherited) conditions at around five days after birth
- a hearing test within four weeks.
Health Visitors have an important role in verifying that universal screening tests have been done and arranging for them to be carried where insufficient information exists as to whether they have been carried out or if retesting is required due to inconclusive results.
For more information, please see NHS Inform's page on Newborn Screening (external link).
Parent information on newborn and childhood screening is available in the Health Scotland leaflet Your guide to newborn screening tests (external link).
Babies and infants are routinely immunised against a range of diseases including diphtheria, tetanus, polio, pertussis and Haemophilus influenzae type b, pneumococcal infection, rotavirus and later against Meningitis C, measles, mumps and rubella. Where appropriate, they may also be immunised against hepatitis B and tuberculosis.
When are immunisations given and what are they?
At two months:
- DTaP/IPV/Hib - protects against Diphtheria, tetanus, pertussis (whooping cough), polio and Haemophilus influenzae type b (Hib)
- Pneumococcal conjugate vaccine (PCV) - protects against pneumococcal infection, one of the most common causes of meningitis and a cause of pneumonia and other conditions such as severe ear infections
- Rotavirus - protects against rotavirus, an infection that causes severe diarrhoea and vomiting in babies and young children.
At three months:
- DTaP/IPV/Hib
- MenC - protects against meningitis and septicaemia (blood poisoning) caused by meningococcal group C bacteria
- Rotavirus - protects against rotavirus, an infection that causes severe diarrhoea and vomiting in babies and young children.
At four months:
- DTaP/IPV/Hib
- Pneumococcal conjugate vaccine (PCV)
At between twelve and 13 months:
- Hib/MenC - protects against Haemophilus influenzae type b (Hib) and meningococcal C (Men C)
- MMR - protects against measles, mumps and rubella (German measles)
- Pneumococcal conjugate vaccine (PCV)
In 2013, the flu nasal spray vaccine will be offered to 2 and 3 year olds as well as a small number of primary school aged children across Scotland.
For a comprehensive overview of routine immunisations, the vaccines used and answers to common questions, please visit the immunisation schedule pages at Immunisation Scotland (external site).
Routine childhood immunisation programme poster
A poster for professionals showing the current routine childhood immunisation programme (plus non-routine immunisations for groups at risk) with a complete list of immunisation types, dates and immunisation sites is available to download from Health Scotland:
Immunisation Timetable Poster 2013 (external link)
How do inequalities impact on childhood immunisations and screening in Scotland?
Overall rates of childhood immunisations in Scotland are high and exceed the 95 per cent target rate at both 12 and 24 months (ISD Scotland: Childhood Immunisation Statistics 2012 (external link)).
However, there is a social gradient whereby rates are lowest among children in the most deprived areas and highest in the least deprived areas, as measured by Scottish Index of Multiple Deprivation 2009 quintiles (ISD Scotland: Primary Immunisation Uptake Rates by Deprivation 2011 (.xls download 192kb)).
Chapter 2 of NICE Public Health Guidance 21: Reducing differences in the uptake of immunisations lists other risk factors for not being properly immunised which including a number of groups known to be at greater risk of experiencing health inequalities. Please see the list below under identifying those at risk.
Identifying those at risk
Midwives, health visitors and GPs should routinely ask parents and check immunisation records in handheld notes (the 'Red Book') as well as other available records whenever they are in contact with a child.
Children in the following groups are identified as being at increased risk of not being properly immunised:
- those who have missed previous immunisations (whether as a result of parental choice or otherwise)
- looked after children (children in local-authority care)
- those with physical or learning disabilities
- children of teenage or lone parents
- those not registered with a GP
- younger children from large families
- children who are hospitalised or have a chronic illness
- those from some minority ethnic groups
- those from non-English speaking families
- vulnerable children, such as those whose families are travellers, asylum seekers or are homeless.
(Ch.2 NICE Public Health Guidance 21: Reducing differences in the uptake of immunisations (external link))
A Pathway of Care for Vulnerable Families (0-3) (external link) sets out key contact points and interactions for those working with vulnerable families of younger children.
- For specific advice for various workforce groups, please see How can I help address inequalities and support childhood immunisations and screening?
