As the new school year starts, with children about to start school for the first time, many parents will have a list of things needed for the big day: haircut, new shoes, school bag, etc. This is an exciting time for families. One important thing for the list is whether their child needs any vaccines. As children starting school will be mixing in larger numbers, the risk of catching infections increases.

Fortunately, although unpleasant, most of these such as cough and colds will be mild even if they are frequent! However, where numbers of unvaccinated children gather, there is also a risk of outbreaks of more serious infections.

Measles is top of the list of potentially serious infections where outbreaks are likely. This is because it is so highly infectious – considered the most infectious – and, to prevent outbreaks, very high uptake (95%) of two doses of measles, mumps, rubella (MMR) vaccine are needed. Unfortunately, this target vaccine uptake has never been met in the UK and current MMR vaccine uptake is the lowest for a decade: 2 in every 10 children in England have not had two doses of vaccine. In London, this figure is as high as ¼ of 5-year-olds entering school, while in some parts of the capital as many as a half of children are not fully vaccinated (NHS Digital 2023).

The situation is such in London that UKHSA has advised that, based on current vaccine uptake, there is the potential for an outbreak of between 40,000 and 160,000 cases (UKHSA 2023). These numbers make it inevitable that there would be many hospital admissions for measles, with complications such as pneumonia and encephalitis as well as deaths. Although large outbreaks are less likely in the country as a whole, there is this possibility where there are pockets of susceptible children, young people and adults.

So, what can be done? Fortunately, we have the means to prevent measles outbreaks through MMR vaccination. It is easy to check children’s vaccination status, by either looking at their red book or, if not available, checking with the GP surgery. Where vaccines are missing, they can be caught up at the GP surgery. Even though vaccines may have been missed at younger ages, for most there is no upper age limit, they can be caught up at any age. This does not require starting the course all over again – they just need the missing vaccines. Older children and young adults are also recommended to have had two doses of MMR vaccine, particularly those who are starting university in the next few months. This is particularly important as many young people missed out on their vaccines when they were young, and we have seen many cases of measles in recent outbreaks in this age group when disease is often more severe.

Don’t forget to also remind parents about the pre-school-booster vaccine. Usually offered at 3 years 4 months along with the second dose of MMR vaccine. This boosts immunity to diphtheria, tetanus, whooping cough and polio through the early school years and is an important part of the vaccine schedule.

Professor Helen Bedford – Professor of Children’s Health, Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health


Also see:

Parent Tips

  • PT – Childhood Immunisations Part 1: An introduction to childhood immunisations
    This Parent Tip provides some useful information on the childhood vaccination programme, explaining how vaccines work, how they are regulated and why it is important to ensure that your baby receives all the recommended immunisations.
  • PT – Childhood Immunisations Part 2: Frequently asked questions
    It is natural to have questions about your baby’s immunisations. This second part of our Parent Tip series on immunisations provides answers to “Frequently Asked Questions” and has been written by leading national experts. It covers FAQs on getting your baby immunised and what to expect, including information on things such as soothing your baby during and after vaccinations, and what to do if they are poorly on the day of their appointment.

Good Practice Points

  • GPP – Promoting the Uptake of Childhood Immunisations
    The immunisation programme in the United Kingdom (UK) is a key component of the Healthy Child Programme. It is important for health visitors to be aware of current research and practice to promote immunisation uptake and know where to go for information.

New campaign warns parents and guardians of serious risk to children’s health from measles and reminds them to ensure their children are protected by taking up two doses of MMR vaccine.


The Institute of Health Visiting supports the call by the UK Health Security Agency (UKHSA) and the NHS for parents and guardians to ensure that their children are up to date with the measles, mumps and rubella (MMR) vaccine, and all other routine childhood immunisations, as the latest data shows MMR vaccination uptake has dropped to the lowest level in a decade.

In a new campaign drive, parents and guardians are being reminded that, during the pandemic, the NHS has continued to provide routine childhood immunisations and they are crucial in protecting children against preventable diseases.

Since the start of the COVID-19 pandemic, in March 2020, there has been a significant drop in the numbers getting their children vaccinated against MMR and other childhood vaccines at the right time.

Coverage for the two doses of MMR vaccine in five year olds in England is currently 85.5%, well below the 95% World Health Organisation’s target needed to achieve and sustain measles elimination. Coverage of the first dose of the MMR vaccine in 2 year olds has dropped below 90%. This means that more than 1 in 10 children under the age of 5 are not fully protected from measles and are at risk of catching it.

Alison Morton, Executive Director at the Institute of Health Visiting, said:

“It is very worrying that more than 1 in 10 five-year-olds are not fully protected against measles. Measles is highly infectious (much more than COVID) and can make children very ill indeed. During the pandemic, the measures we have all taken to protect ourselves and our communities from infection resulted in a reduction in measles. However, this does not mean it has disappeared. Measles is waiting in the wings and it only takes a small fall in vaccine uptake for us to start having outbreaks. Fortunately, it is never too late to have the MMR vaccine, two doses are needed to give best protection. The vaccine is also very safe.

“Parents can check their child’s red book to see if they have had their two doses. If they have not, or it is not clear, parents should contact their GP practice and book an appointment. Combatting measles will take a whole system approach and health visitors are ideally placed to support parents to access the vaccine for their child, and also answer their questions if they are unsure or have concerns.”

Measles is highly contagious, so even a small decline in MMR uptake can lead to a rise in cases. As international travel resumes, it is more likely that measles will be brought in from countries that have higher levels of the disease and so it is important that we recover MMR vaccination rates to help prevent a rise in cases.

Measles can lead to complications such as ear infections, pneumonia, and inflammation of the brain which require hospitalisation and on rare occasions can lead to long term disability or death. Since the introduction of the measles vaccine in 1968 it is estimated that 20 million measles cases and 4,500 deaths have been prevented in the UK.

New research commissioned by the Department of Health and Social Care and the UKHSA, conducted by Censuswide, shows that many parents are not aware of the risks that measles poses to their unvaccinated children.

Out of 2,000 parents and guardians of children aged five and under:

  •  Almost half (48%) are not aware that measles can lead to serious complications such as pneumonia and brain inflammation
  • Only 4 in 10 (38%) are aware measles can be fatal
  • More than half of parents (56%) are not aware that two doses of the MMR vaccine gives 99% protection against measles and rubella

Children are offered two doses of the MMR vaccine by their registered GP surgery – the first when they turn 1-year old and the second at around 3 years and 4 months, before they start nursery or school. The NHS has continued to prioritise routine vaccinations throughout the pandemic, however some parents who haven’t had their child vaccinated against MMR said this was because they didn’t realise the NHS was still offering appointments, or they didn’t want to burden the NHS.


The statement from the Joint Committee on Vaccination and Immunisation (JCVI) on immunisation prioritisation has been published on maintaining immunisation services to reduce the serious risk of vaccine-preventable disease.

The key messages are:

  • Providing those attending for vaccination (including parents of babies) are well, are not displaying symptoms of COVID-19 or other infections and are not self-isolating because they are contacts of suspected COVID-19 cases, immunisation should proceed.
  • Most children suffer from a very minor illness with COVID-19. If immunisation services lapse, there will be consequential substantially increased risk to health from vaccine-preventable diseases. It is vital that we sustain services.

PHE has announced the beginning of the flu season.

They have asked for your support in promoting the flu vaccine – particularly for toddlers aged 2 and 3. Their latest data shows that uptake in this group is lower than the previous season due to the earlier delays of the children’s vaccine.

The delays have now been resolved. Parents should contact their GP for a free flu vaccine, which is just a quick and easy nasal spray, as soon as possible.

Flu can be horrible for little children and if they get it, they can spread it round the whole family.

Watch short videos below:

From September 2019, boys in school year 8 will be offered the free Human Papilloma Virus (HPV) vaccine for the first time.

Worldwide, about 5% of all cancers are linked to the HPV virus. This includes cervical, penile, anal and genital cancers and some cancers of the head and neck – all of which the vaccine helps to protect against. Cervical cancer is currently the most common cancer in women under 35, killing around 850 women each year. HPV is thought to be responsible for over 99% of cervical cancers, as well as 90% of anal, about 70% of vaginal and vulvar cancers and more than 60% of penile cancers.

Modelling produced by the University of Warwick estimates that by 2058 in the UK the HPV vaccine currently being used may have prevented up to 64,138 HPV-related cervical cancers and 49,649 other HPV-related cancers.  This would be 50 years after the introduction of the HPV vaccination programme, when people who were vaccinated as teenagers have reached the age groups that they would typically be affected by HPV-related cancers.

Girls have been offered the human papilloma virus (HPV) vaccine free from the NHS since 2008. So far, ten million doses of HPV vaccine have been given to young women in this country meaning over 80% of women aged 15-24 have received the vaccine. Since the introduction of HPV vaccination, infections of some types of HPV (HPV 16/18) in 16-21 year old women have reduced by 86% in England. A Scottish study also showed that the vaccine has reduced pre-cancerous cervical disease in women by up to 71%. Similarly, diagnoses of genital warts have declined by 90% in 15-17 year old girls and 70% in 15-17 year old boys due to the HPV vaccine.

Parents of girls and boys aged 12 and 13 should look out for information from their children’s school about the vaccine and timings for the jab. If they miss out on the vaccination for any reason they should talk to their school nurse/immunisation team about getting the vaccine at a later date.

More information about HPV vaccination for parents and their children is available here (see HPV).

Guidance for health professionals to share with pregnant women immunised with MMR (measles, mumps, rubella), chickenpox or shingles vaccines.

This advice provides information on the safety of each vaccine when given in pregnancy for health professionals to share with pregnant women who have been inadvertently vaccinated.

From Public Health England – Documents for parents and carers explaining the use of the unlicensed BCG vaccine.

Since late 2015, there has been a global shortage of the BCG vaccine. To protect those at risk Public Health England has secured a limited supply of BCG vaccine for babies who are eligible.

These documents explain why a brand of BGC vaccine without a UK licence is being used and why it is still recommended.