Paeds · clinical-pharmacology-and-therapeutics
Vaccines and immunobiology
Also known as Childhood immunisation schedule · Live vaccine contraindications · Catch-up vaccination · Vaccination in immunocompromised children · Rotavirus vaccination age limits
A fellowship approach to vaccines and immunobiology in children covering the scheduled immunisation programme with on-time dosing at birth, two, four, six, twelve and eighteen months, the distinction between live attenuated vaccines (measles-mumps-rubella, varicella, rotavirus, BCG, yellow fever) and inactivated subunit, toxoid, conjugate and recombinant vaccines, the absolute contraindications to live vaccines of significant immunocompromise and pregnancy, the four-week spacing rule when two live vaccines are not given on the same day, the strict rotavirus age limits with the first dose before fifteen weeks and the course complete by twenty-four weeks, vaccination of premature infants by chronological age with full doses and no reduction, catch-up scheduling built on minimum intervals rather than restarting, and the recognition and management of adverse events following immunisation including anaphylaxis.
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Red flags
- A live vaccine (measles-mumps-rubella, varicella, rotavirus, BCG) given to a child with significant immunocompromise — primary immunodeficiency, malignancy on chemotherapy, high-dose corticosteroids, transplant, or biologic immunosuppression
- A live vaccine administered in pregnancy, or a woman becoming pregnant within four weeks of receiving a live vaccine
- Two injectable live vaccines given less than four weeks apart rather than on the same day — the second dose does not count and must be repeated
- Rotavirus vaccine first dose given at or after fifteen weeks, or the course completed after twenty-four weeks, breaching the strict age limits
- Delaying or splitting vaccines in a premature infant rather than vaccinating by chronological age with full doses
- Dismissing a child who becomes unwell shortly after vaccination without assessing for anaphylaxis, intussusception, or a febrile seizure
- Giving rotavirus vaccine to an infant exposed to a biologic immunosuppressant such as a tumour necrosis factor inhibitor in utero, before drug clearance is confirmed
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Allergy and Immunology
- Infectious Diseases
- Current 2026 PREP curriculum — Learning Objective: Safe prescribing and medication management in infants, children and young people
- Current 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young person
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 9: Quality and safety, including medication safety
- Clinical Applications
- Medical Sciences
- Long Cases
- Short Cases
- 1. Clinical: Child presenting with an immunisation question or adverse event
- 2. Safeguarding and health promotion: delivers the immunisation programme and catch-up correctly
- 7. Patient safety, including safe prescribing and vaccine cold-chain
- 8. Quality improvement and population health through immunisation uptake
- Foundation of Practice (FOP)
- Theory and Science (TAS) — immunology of vaccination
- Applied Knowledge in Practice (AKP)
- Communication
- History
- Clinical
- General Pediatrics Content Outline — Domain 10: Principles of Pharmacology and Medication Management
- General Pediatrics Content Outline — Universal Task 2: Health Maintenance and immunisation
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- Systems-Based Practice 2: Population and public-health immunisation
- Patient Safety/Quality Improvement 1: Medication and vaccine safety, cold-chain, and adverse-event reporting
- Medical Knowledge 2: Diagnostic and Therapeutic Decision Making
- Health Advocate
- Medical Expert
- Pediatrics: Core EPA #5 — Recommending and Initiating Pharmacologic Interventions
Overview & Definition
Picture a six-week premature baby reaching two months of age in the neonatal unit, a four-year-old newly arrived from overseas whose immunisation record is incomplete, and a twelve-year-old on methotrexate for juvenile idiopathic arthritis whose second measles-mumps-rubella dose is overdue. Each of them needs a vaccination decision, and each tests a different part of the immunisation pathway — on-time dosing, catch-up, and the live-vaccine rule. [1] [2]
Two ideas carry the whole topic. The first is the on-time, on-schedule principle: every dose is given at the recommended age, because timely, high-coverage vaccination is what prevents outbreaks of vaccine-preventable disease and protects those who cannot be vaccinated. The second is the right-vaccine, right-child rule: before any vaccine is given you confirm there is no contraindication, check the interval since any live vaccine or blood product, and verify the child's record — and a child who is behind is caught up, never turned away. [1] [9]
From the first contact to a child safely vaccinated
- 1
1 · Confirm the child and the record
Identify the child, review the immunisation history, and confirm the vaccines due at this visit against the schedule.
- 2
2 · Screen for contraindications
Check for significant immunocompromise, pregnancy, a severe prior reaction, and the interval since any live vaccine or blood product.
- 3
3 · Decide live versus inactivated
Confirm whether a live vaccine is safe for this child, and apply the four-week spacing rule for two live vaccines not given on the same day.
- 4
4 · Give the vaccines on time
Administer at the correct age, site, and route, observe the child afterwards, and document each dose in the register.
- 5
5 · Catch up the gaps
Use minimum intervals to catch up any missed doses, report adverse events, and arrange the next visit.
References12ShowHide
- [1]Wiley CC Immunizations: vaccinations in general Pediatrics in review, 2015.PMID 26034255
- [2]Miller K; Leake K; Sharma T Advances in vaccinating immunocompromised children Current opinion in pediatrics, 2020.PMID 31790029
- [3]Omeñaca F; Vázquez L; Garcia-Corbeira P; Mesaros N; et al Immunization of preterm infants with GSK's hexavalent combined diphtheria-tetanus-acellular pertussis-hepatitis B-inactivated poliovirus-Haemophilus influenzae type b conjugate vaccine: a review of safety and immunogenicity Vaccine, 2018.PMID 29336924
- [4]Kerth JL; Kurz C; Obitz J; Vogel T; et al In-hospital rotavirus vaccination in premature and medically ill infants: a systematic review of uptake and safety Molecular and cellular pediatrics, 2026.PMID 42118471
- [5]Koch J; Harder T; von Kries R; Wichmann O Risk of intussusception after rotavirus vaccination Deutsches Arzteblatt international, 2017.PMID 28468712
- [6]Gershon AA; Gershon MD; Shapiro ED Live attenuated varicella vaccine: prevention of varicella and of zoster The Journal of infectious diseases, 2021.PMID 34590140
- [7]Tchakoute CT; Hesseling AC; Kidzeru EB; Gamieldien H; et al Delaying BCG vaccination until 8 weeks of age results in robust BCG-specific T-cell responses in HIV-exposed infants The Journal of infectious diseases, 2015.PMID 25108027
- [8]Danziger-Isakov L; Kumar D; AST ID Community of Practice Vaccination of solid organ transplant candidates and recipients: guidelines from the American society of transplantation infectious diseases community of practice Clinical transplantation, 2019.PMID 31002409
- [9]Niewiesk S Maternal antibodies: clinical significance, mechanism of interference with immune responses, and possible vaccination strategies Frontiers in immunology, 2014.PMID 25278941
- [10]Quinn SC; Jamison AM; Freimuth VS Measles outbreaks and public attitudes towards vaccine exemptions: some cautions and strategies for addressing vaccine hesitancy Human vaccines and immunotherapeutics, 2020.PMID 31403354
- [11]Michel R; Berger F; Ravelonarivo J; Dussart P; et al Observational study on immune response to yellow fever and measles vaccines in 9 to 15-month old children. Is it necessary to wait 4 weeks between two live attenuated vaccines? Vaccine, 2015.PMID 25843268
- [12]Wieringa JW; Kruizinga MD; Driessen GJA; van der Woude CJ; et al Validation of the pharmacokinetic model for anti-TNFα clearance in infants exposed to anti-TNFα during pregnancy Journal of crohn's and colitis, 2024.PMID 37823516