Price per dose: £100 for BCG AJV made in Denmark which is the only BCG vaccine licensed in the UK; see the official product insert information here

Number of doses for primary course: 1
Minimum dose intervals: –
Age: Birth onwards*
When a booster dose given (in years): None required

BCG can be administered at any time before or after other vaccines:

*Children born on or after 1 September 2021 are required to bring in confirmation of a negative new-born heel prick test result, also known as newborn blood spot screening or confirmation that the child was not offered such screening before we can administer the BCG vaccine.

Parents will need to bring their Red Book AND the letter with the outcome of the newborn’s bloodspot screening with them to their appointment.

Vaccination may be administered earlier than 28 days provided that a heel prick test result is available, along with proof.

Price per dose: £85

Number of doses for primary course: 1
Minimum dose intervals: –
Age: Birth onwards
When a booster dose given (in years): –

Price per dose: £40

Please bring a photographic proof of identity (e.g. driving license or passport) to your appointment. 

A certificate will be provided.

Price per dose: £70
Number of doses for primary course: 2
Minimum dose intervals: 3 month for 9-12 months of age & 1 year+ 4 weeks
Age: 9 month+
When a booster dose given (in years): None required

Giving Chickenpox (varicella) and MMR vaccines:

Price per dose: £74 for two doses
Number of doses for primary course: 2 for 6 years+ & 3 for 2-6 years
Minimum dose intervals: 1 week
Age: 2+
When a booster dose given (in years): 2 years for 6 years+ & 6 months for 2-6 years of age

Can this vaccine provide protection against travellers diarrhoea?

In clinical trials Dukoral has shown efficacy in protecting against infection by ETEC (Enterotoxigenic Escherichia coli), a common cause of travellers’ diarrhoea.
The vaccine is not licensed in the UK for use in protecting against either ETEC infection or travellers’ diarrhoea (only licensed for cholera); this vaccine may be considered for travellers’ diarrhoea for

1. Travellers for whom even a brief episode of diarrhoea could be consequential (e.g. other underlying medical condition).
2. Travellers prone to severe diarrhoea.

Price per dose: £38
Number of doses for primary course: 1
Minimum dose intervals: –
Age: 6+
When a booster dose given (in years): 10

This is a 3 in 1 vaccine called Revaxis, used as travel & tetanus vaccinations after an accident or injury.

Why do we give tetanus boosters to travellers when only five doses of tetanus are needed for life in the UK with no additional boosters?

It is correct that only five doses of tetanus are needed for life in the UK, but this is on the assumption that if someone needed a tetanus booster or immunoglobulin (e.g. in the event of a tetanus prone wound) they would be able to access the appropriate treatment easily.

We give boosters to travellers if we cannot be sure they would be able to quickly access appropriate treatment easily. Particularly in countries where medical facilities and supplies are scarce, obtaining tetanus immunoglobulin might be difficult. Rather than take this chance, we would give them further vaccine before departure.

Price per dose: £92
Number of doses for primary course: 2
Minimum dose intervals: 0 & 6-12 months 
Age: 1-15
When a booster dose given (in years): See individual vaccines

This vaccine is brand name is Ambirix and it would simplifies long-term protection from both infections with only two doses, 6 months apart.

Price per dose: £119
Number of doses for the primary course: 2
Minimum dose intervals: 3 months (majority of protection comes from the 1st dose)
Age: 4+
When a booster dose given (in years): Not yet established - should be effective for at least around 5 years after 2 doses

21 March 2024

Qdenga is a live vaccine and the only dengue vaccine approved by the UK medicines regulator (MHRA) for use in individuals regardless of previous dengue exposure.  See the official insert of the only UK dengue vaccine (Qdenga) here: https://www.medicines.org.uk/emc/files/pil.14663.pdf

However, based on the the Joint Committee on Vaccination and Immunisation (JCVI)'s draft minutes published on 21 March 2024, JCVI concluded that in relation to UK travellers, Qdenga could be offered where individuals had a prior dengue infection.  The JCVI said, currently, they couldn’t recommend vaccination for individuals with no previous dengue infection.

The JCVI said the information from clinical trials to date is insufficient to make a recommendation for those with no previous dengue infection.  There is a theoretical risk of severe dengue if a person with no previous dengue infection is vaccinated and then is later infected with dengue virus DENV 3 or DENV 4 serotypes [even though as yet no safety concerns have been seen in 4.5 years of clinical trials].

More data is due on early 2025, so this advice could change in the future.  If you had your first dose BEFORE the JCVI guidance on March 2024 with no previous dengue infection, it is advisable to still receive the 2nd dose.

The JCVI said that due to the high number of asymptomatic cases, travellers may not be aware they had had dengue.  It would therefore be reasonable to consider vaccination for those who regularly visit family/friends or have been working/living abroad in high burden endemic areas.  There may be an element of judgment required even if there had been illness that they had been told was dengue.  There should be discussion with travel specialists to ensure that individuals can make an informed decision with knowledge of the risk of being vaccinated if seronegative.

A blood test to explore previous asymptomatic dengue infection can assist in making this decision.  We offer the Dengue Virus Serology at the discounted cost of £142.  The decision to offer Qdenga will ultimately be made jointly by the responsible clinician and the traveller, informed by the available information.  The decision to offer vaccination to individuals should also be informed by future travel plans and the risk of exposure.

JCVI and UKHSA will draft guidance on best practice to establish evidence of previous dengue infection, to inform vaccination decisions.  This will be contained in the new dengue chapter in the Green Book.

JCVI minutes:

https://app.box.com/s/iddfb4ppwkmtjusir2tc/file/1477553418407 https://app.box.com/s/zgwbfkusqvyc9wzbbrsumbhmbecswlg5/file/1477568661544

Information on dengue and the Qdenga

When compared to other diseases that travellers are regularly vaccinated against, there may be a higher risk of contracting dengue.  See Incidence rate per month of vaccine-preventable diseases in travellers; best estimate for non-immunes - Journal of Travel Medicine, taad085, https://doi.org/10.1093/jtm/taad085 June 2023

The burden of dengue has become heavier dramatically in the past 30 years and it occurs mostly in urban and semi-urban areas.

Travellers who spend long periods in endemic areas are at increased risk. However, even short-term visitors may be exposed.

The risk for severe dengue is greater during a second dengue infection; although severe dengue also can occur during the first, third, or fourth infection.

Although dengue is rarely fatal in travellers it can be disruptive and lead to significant costs. There would be a clear benefit from Qdenga for those who have had dengue before. There would be a lower benefit for individuals who have not had dengue before, against DENV1 and 2, and no demonstrated benefit against DENV3 and 4.

Individuals with dengue should wait around 12 months after the date the dengue illness is confirmed by a test to begin the Qdenga vaccine series.  This is because the immune responses activated after the dengue infection may inactivate the live vaccine for few months.

Key relevant resources

Qdenga® Dengue Vaccine Guidance from the England National Travel Health Network and Centre (NaTHNaC): https://travelhealthpro.org.uk/news/763/qdenga-dengue-vaccine-guidance?fbclid=IwAR3yvChuQh-S4vUnSPPDbpYUIAW6nRxMSFsV3TnKGNe-ap5ETGlGWiLOT3c

List of the countries with risk of dengue: https://www.cdc.gov/dengue/areaswithrisk/around-the-world.html

Dengue Map - up-to-date information on areas where dengue has recently been reported: https://www.healthmap.org/dengue/en/

US Government Centers for Disease Control and Prevention Health's Yellow Book 2024 | Travelers' Health | Dengue: https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/dengue

Price per dose: £108
Age: 2 months+

Infanrix-IPV+Hib: INFANRIX-diphtheria tetanus pertussis (acellular), poliomyelitis and hib vaccine – Patient Information Leaflet (PIL) – (emc) (medicines.org.uk)

If a haemophilus influenzae type b (Hib) vaccine is required the Hib/MenC vaccine can be used:

Menitorix: Menitorix Powder and solvent for solution for injection – Patient Information Leaflet (PIL) – (emc) (medicines.org.uk)

Price per dose: £48
Number of doses for primary course: 1
Minimum dose intervals: –
Age: 16+
When a booster dose given (in years): 25 years after the 2nd dose*

*UKHSA 'green book' recommends that until further evidence is available on persistence of protective immunity, a booster dose at 25 years is indicated for those at ongoing risk of hepatitis A.

I had one dose of hepatitis A vaccine many years ago but did not complete the course. Should I restart the whole course of vaccination now?

There is no need to restart the whole course of vaccination – one dose now will be sufficient to complete the course.

How long does it take for hepatitis A vaccine to give protection?

Approximately 14 days after the primary vaccination. The average incubation period for hepatitis A infection is 28 days (and can be 3 – 5 weeks) so it may still be worthwhile giving the vaccine at short notice prior to travel.

For more information and the vaccine schedules see here.

Price per dose: £45
Number of doses for primary course: 1
Minimum dose intervals: –
Age: 1-15 - also see below for details of vaccinating under 1 year of age
When a booster dose given (in years): Protection from a single dose lasts for at least one year and 25 years after the 2nd dose

UK Guidance:

Immunisation with hepatitis A vaccine is recommended for those aged one year and over travelling to areas of high, medium hepatitis A endemicity, or occasionally during hepatitis A outbreaks.

The risks of disease for children under one year old are low, and vaccines are not licensed for their use at this age. Care should be taken to prevent exposure to hepatitis A infection through food and water.

US Guidance:

If at risk, infants 6 to 11 months old should also be vaccinated against Hepatitis A. The dose does not count toward the routine 2-dose series.

For more information and the vaccine schedules see here.

Price per dose: £43
Number of doses for primary course: 3 or 4
Minimum dose intervals: 0, 1, 2 months (3 dose schedule – if there is not enough time, 2 doses provide reasonable protection before travel) or rapid schedules: 0, 7, 21 days & 12 months (4 dose schedule).

Age: 16+
When a booster dose given (in years): None required for travel

For travellers who have completed a primary course of vaccination, a single booster dose of vaccine at five years is not required, unless they are considered to be at continuing risk of infection e.g. regular traveller to areas with poor health care and high incidence of hepatitis B carrier rate. They would also be advised to have a booster if in an at risk situation e.g. needle stick injury. Any traveller with an underlying medical condition that may compromise their response to vaccine should consider a test.

When are rapid schedules used in preference to the standard schedule?

Suitable for travellers who require maximum protection but do not have time for the standard 3 dose schedule.

Why do the rapid schedules have a 4th dose of vaccine?

The additional 4th dose at 12 months is given because some initial protection from the 3 rapid doses may be lost. This only applies to infants who are at continued risk and those who receive the very rapid schedule on days 0, 7 and 21.

For more information and the vaccine schedules see here.

Price per dose: £39
Number of doses for primary course: 3
Minimum dose intervals: 0, 1, 2 months
Age: 0-15
When a booster dose given (in years): None required for travel

Now that hepatitis B vaccine is included in the UK national schedule, does this mean we no longer need to vaccinate children travellers?

Children born after August 1st 2017 will receive hepatitis B vaccine and will be protected after completion of the course of vaccination. Children born before 1st August 2017 will not have been given hepatitis B vaccine routinely and may therefore still need to be considered prior to travel or as routine immunisation given privately.

For more information and the vaccine schedules see here.

Price per dose: £165
Number of doses for primary course: 2 for 9-14 years & 3 for over 14
Minimum dose intervals: 0, 1, 4 months
Age: 9+ there is no upper age limit

When a booster dose given (in years): Not required

See the vaccine insert here:

https://www.medicines.org.uk/emc/product/7330/pil#about-medicine

Price per dose: £20

We vaccinate children 6 months of age and over with flu injection.

Children would need an appointment,  whereas adults can walk-in. 

For more information and the vaccine schedules see here.

Subject to stock availability

Price per dose: £38 

Number of doses for primary course: 1
Minimum dose intervals: –
Age: 2-18
When a booster dose given (in years): 1

Subject to stock availability.

The nasal flu vaccine can be administered at any time before or after other vaccines.

For more information and the vaccine schedules see here.

Price per dose: £102
Number of doses for primary course: 2
Minimum dose intervals: Standard schedule: 0 & 28 day – Rapid schedule: 0 & 7 day. 

Age: 2 month+
When a booster dose given (in years): 2 years for 1st booster and *10 years for 3rd booster

What are the benefits of the rapid schedule versus the normal day 0 and 28 day schedule?

The main benefit of the rapid schedule is that it can be used for those travellers leaving in less than one month. Ideally both doses should be given at least one week prior to exposure to Japanese encephalitis.

When do I need to give a booster following the rapid schedule?

The 1st booster (for the purpose of travel) is the same after standard or rapid primary schedule.

• Children (from 2 months) and adults under 65 years: boost 12-24 months after primary immunisation and prior to potential re-exposure to Japanese encephalitis virus.
• Adults 65 years of age and older: consider boost at 12 months for those at risk.

2nd booster (4th dose)

• 10 years after 1st booster (3rd dose) should be offered to those that remain at risk *(the 10 year protection is only applied to adults 18-64 years of age – all other ages, if at risk, require a booster dose after 2 years).

For more information and the vaccine schedules see here.

Price per dose: £135
Number of doses for primary course: 2
Minimum dose intervals: 1-2 months depends on the age
Age: 2 months+
When a booster dose given (in years): Not required

See the official vaccine insert here 

Price per dose: £70
Number of doses for primary course: 

Infants from 6 weeks to less than 6 months of age: two doses, each of 0.5 ml, should be administered with an interval of 2 months between doses.

Infants from 6 months of age, children, adolescents and adults: a single 0.5 mL dose should be administered.

Minimum dose intervals: See above.
Age: 6 weeks+ 
When a booster dose given (in years): 5 years for travel

The MenACWY vaccine we usually use is called Nimenrix.

Price per dose: £48
Number of doses for primary course: 2
Minimum dose intervals: 4 weeks
Age: 1+*
When a booster dose given (in years): Not required

It is critical, therefore, for all international travelers to be protected against measles, regardless of their destination.

*Infants from six months of age age travelling to measles endemic areas with a high incidence of measles or to an area where there is a current outbreak, who are likely to be mixing with the local population, should receive MMR.  

As the response to MMR in infants is sub-optimal where the vaccine has been given before one year of age, immunisation with two further doses of MMR should be given at the recommended ages.  Children who are travelling who have received one dose of MMR at the routine age should have the second dose brought forward to at least one month after the first.  If the child is under 18 months of age, then the routine pre-school dose (a third dose) should be given in order to ensure full protection. (Green Book, chapter 21).

There is good evidence that administering measles-containing vaccines to infants younger than 9 months induces a good immune response, confers protection, and is safe.  Administration of MMR vaccine to children under 9 months constitutes off-label (unlicensed) use of the vaccine but should be considered.

Recommendations for measles vaccinations for travellers:

1. Infants (6 through 11 months old). One dose of a measles containing vaccine should be given. This dose does not count as the first dose in the routine childhood vaccination series.
2. People 12 months old or older, without other presumptive evidence of measles immunity. Two appropriately spaced doses of a measles containing vaccine should be given.
3. People 12 months old or older who have written documentation of one dose and no other presumptive evidence of measles immunity. One additional dose before travel.

There is now overwhelming evidence that MMR does not cause autism.

Also, it has been suggested that combined MMR vaccine could potentially overload the immune system. From the moment of birth, humans are exposed to countless numbers of foreign antigens and infectious agents in their everyday environment. Responding to the three viruses in MMR would use only a tiny proportion of the total capacity of an infant’s immune system. The three viruses in MMR replicate at different rates from each other and would be expected to reach high levels at different times (Green Book, chapter 21).

If the measles containing vaccine is given to someone who turns out to be already immune either due to previous infection or previous vaccination, will it do any harm?

No. There are no ill effects from vaccinating such individuals as they will have pre existing immunity that inhibits replication of the vaccine viruses.

Giving Yellow Fever and MMR vaccines:

A four week minimum interval period should be observed between the administration of these two vaccines. Yellow Fever and MMR should not be administered on the same day.

Giving Chickenpox (varicella) and MMR vaccines:

If these vaccines are not administered on the same day, then a four week minimum interval should be observed between vaccines.

Giving Tuberculin skin testing (Mantoux) and MMR vaccines:

If a tuberculin skin test has already been initiated, then MMR should be delayed until the skin test has been read unless protection against measles is required urgently. If a child has had a recent MMR, and requires a tuberculin test, then a four week interval should be observed.

Price per dose: £57
Number of doses for primary course: 1
Minimum dose intervals: –
Age: 2+

• Pneumococcal pneumonia is a potentially serious bacterial lung disease that can strike anytime without warning
• Don't confuse pneumococcal pneumonia with the flu
• Pneumococcal pneumonia can cause your lungs to fill with mucus, making it hard to breathe
• It can disrupt your life for weeks
• Symptoms can be severe

Pneumococcal polysaccharide vaccine (also known as Pneumovax 23 or PPSV23 or PPV23) is used by the NHS as a one-off vaccination for everybody 65 years of age and over OR those 2 years of age and over with specific chronic conditions, such as diabetes.

As a non-NHS service, we offer the following recommendations based on the latest CDC advice:

Pneumococcal conjugate vaccines are generally provide better and longer lasting protection than the PPSV23  (see here for more information).

PPSV23 is no longer recommended alone, however PPSV23 is recommended for adults after PCV13 or PCV15 vaccination (i.e. pneumococcal conjugate vaccines). PPSV23 is not recommended for people who have previously received a pneumococcal 20-valent conjugate vaccine (known as PCV20 or Apexxnar in the UK and Prevnar 20 in the US) vaccination.

CDC recommends PCV20 as an option for pneumococcal disease prevention in adults age 19 years or older who have not previously received a pneumococcal conjugate vaccine (those born prior to 2006 have not had a pneumococcal conjugate vaccine as part of their routine immunisation). 

If PCV20 is given, no further pneumococcal vaccination is recommended.

PCV20 is an option for adults 19 through 64 at increased risk for invasive pneumococcal disease due to behavioral or medical risk factors OR for adults age 65 or older.

See the official insert of the PPSV23 here

Price per dose: £97
Number of doses for primary course: 1
Minimum dose intervals: –
Age: 18+

• Pneumococcal pneumonia is a potentially serious bacterial lung disease that can strike anytime without warning
• Don't confuse pneumococcal pneumonia with the flu
• Pneumococcal pneumonia can cause your lungs to fill with mucus, making it hard to breathe
• It can disrupt your life for weeks
• Symptoms can be severe

Pneumococcal 20-valent conjugate vaccine (known as PCV20 or Apexxnar in the UK and Prevnar 20 in the US) helps protect against more strains of the bacteria that cause pneumococcal pneumonia than any other pneumococcal conjugate vaccine (i.e. PCV13 and PCV15).

Pneumococcal conjugate vaccines are generally provide better and longer lasting protection than the Pneumovax 23 (also known as Pneumovax 23 or PPSV23 or PV23) - see here for more information

Even if you’ve already been vaccinated with another pneumonia vaccine, PCV20 can help provide additional protection. 

Pneumococcal polysaccharide vaccine (Pneumovax 23) is used by the NHS as a one-off vaccination for everybody 65 years of age and over OR those 2 years of age and over with specific chronic conditions, such as diabetes.

As a non-NHS service, we offer the following recommendations based on the latest CDC advice:

• Pneumovax 23 is no longer recommended alone, however Pneumovax 23 is recommended for adults after PCV13 or PCV15 vaccination (i.e. pneumococcal conjugate vaccines).
• Pneumovax 23 is not recommended for people who have previously received a PCV20 vaccination.

CDC recommends PCV20 as an option for pneumococcal disease prevention in adults age 19 years or older who have not previously received a pneumococcal conjugate vaccine (those born prior to 2006 have not had a pneumococcal conjugate vaccine as part of their routine immunisation). 

If PCV20 is given, no further pneumococcal vaccination is recommended.

PCV20 is an option for adults 19 through 64 at increased risk for invasive pneumococcal disease due to behavioral or medical risk factors OR for adults age 65 or older.

See the official insert of the  PCV20 here

Jan 2024: We have the UK approved rabies vaccine (Rabipur) available now

Intradermal (ID) injection: £55 

Currently, the manufacturers of rabies vaccines do not have UK marketing authorisation for administration of the rabies vaccine by ID injection. However, the ID injection of rabies vaccine is as safe and effective as the IM route and is supported by World Health Organization (see page 207).  We discuss this with you at your appointment.

Number of doses for primary course: 3 if given with minimum intervals of 0, 7, 21 days, otherwise if no time, 4 doses required given at 0, 3, 7 & 365 days.

Intramuscular (IM) injection: £79 – subject to stock availability

Minimum dose intervals: 

Conventional regimen: 0, 7, 21 days

Rapid Regimen (adults only – if not able to complete the conventional regimen): 0, 3, 7 & 365 days.

Age: Birth onward

Rabies is almost always fatal once symptoms appear. See here a very sad recent example: https://www.bbc.co.uk/news/uk-46180330 

Rabies cases are rare in travellers BUT animal bites and scratches are not, travellers should be aware of the risk and know what to do if they are bitten or scratched.

Current pre-exposure prophylaxis recommendations in England

The need for boosters will depend on the activities being undertaken by the traveller, the rabies risk in the country being visited and the ability to access post-exposure medical care and rabies biologics. A booster may also be considered for those travellers with primary vaccination more than five years previously.

Key in the risk assessment when deciding when to vaccinate is whether post exposure treatment, which is necessary following an animal bite, is readily available. Post exposure treatment in someone who has not been vaccinated entails immediate first aid, administration of Human Rabies Specific Immunoglobulin (HRIG) followed by a course of five rabies vaccinations over 28 days. The HRIG and first dose of vaccine should ideally be started within 24 hours of the bite being inflicted. HRIG is known to be very difficult or impossible to obtain in many countries, so unvaccinated travellers who receive an animal bite may need to travel to another country or even come home for treatment.

When does a booster dose given?

Routine booster doses are not recommended for most travellers. However a single booster dose of vaccine can be considered following a risk assessment in those who have completed a primary course over one year ago and are travelling again to a high risk (enzootic) area. A complete primary course is considered to be a three dose pre-exposure immunisation course over 21-28 days or an accelerated three dose course over 7 days plus an additional dose at one year or at the first opportunity after one year.

If you have rabies vaccine prior to travel does this mean that you don’t need any treatment if you get an animal bite while away?

No – they will still need treatment but this is much simpler and more as a precaution rather than an emergency. After the full course or pre-exposure rabies vaccine, a fully immunocompetent recipient should produce protective antibodies against rabies. Immediate first aid should be carried after any animal bite. In the event of an animal bite in a high or intermediate risk area, this should be followed up with two further doses of rabies vaccine on days 0 and 3, to be given as quickly as possible after the animal bite. HRIG is not needed.

If a traveller is bitten by an animal, how would they know if the animal has rabies or not?

You cannot tell by looking at an animal whether it has rabies or not as symptoms are not always apparent. Although it is possible to determine whether an animal has rabies through laboratory testing (usually on a dead animal), for most travellers this is impossible.

Rabies, once symptoms develop, is always fatal, so every animal bite in a high risk area should be treated as an emergency.

In countries where there is a low risk of animal rabies, travellers should still have any bite assessed quickly to ascertain if further action is required.

Remember, even in countries with no risk of animal rabies, bats may be infected.

How can I find out whether HRIG is available in the country my traveller is going to?

In most cases you can’t. HRIG is not in plentiful supply anywhere. Though it can be found when needed in most developed countries, in underdeveloped countries, including those with the highest risk of rabies, it will be very difficult or impossible to obtain HRIG.

It is worth noting that HRIG is produced from blood products, so even though this is essential for treatment for someone not previously vaccinated, it may pose a risk in itself in many countries.

What is the advice to travellers about monkey bites?

Travellers should be advised to never handle or feed monkeys. Should a traveller sustain a monkey bite or scratch then prompt first aid is important. Thorough irrigation is important and as with any infection, use of a chlorhexidine containing soap or detergent will reduce the transmission of infection.

Post exposure rabies treatment should be administered.

Tetanus vaccine +/- tetanus immunoglobulin should be given if the traveller is unvaccinated.

Antibiotic is usually advised.

Post-exposure prophylaxis for herpes B infection is unnecessary in travellers post- wild monkey bite, even from a rhesus macque monkey. Good patient education with advice to seek prompt medical attention if they develop a blistering eruption at the site of the bite or develop a ‘flu like’ illness within the 3 week post bite is important to facilitate early diagnosis and treatment of any infection.

Arexvy (manufactured by GSK) is the first ‘respiratory syncytial virus’ (RSV) vaccine for adults authorised in the UK, EU and USA.

In the UK, RSV infections typically occur in the autumn and winter, and begin to offset in the spring.

There is no treatment for RSV, other than supportive care, for older adults.

There is a substantial burden of RSV infection in older adults, which contributes to the seasonal winter pressures for the NHS.

CDC recommends RSV vaccine for older adults.

Arexvy is given as a single dose injection to protect adults aged 60 years and older against RSV.

Arexvy may be given at the same time as a flu vaccine, in a single visit. 

It's advisable to observe at least a 7 day interval with other vaccines.

Price is £230.

Trial findings

Safety

• The local administration site adverse reactions reported with Arexvy had a duration of 2 days on average.
• The systemic adverse reactions (fatigue, muscle aches and pain, headache, joint pain and fever) reported with Arexvy had duration ranging between 1 and 2 days.
• Similar rates of serious adverse events (4.2% vs 4.0%), deaths (0.4% vs 0.5%), and F (0.3% vs 0.3%) were reported between participants who received Arexvy (n=12,467) and placebo (n=12,499), respectively.

RSV is a common respiratory virus that usually causes mild cold-like symptoms but can be serious in vulnerable people including babies, older adults, and those with underlying conditions such as diabetes.

This vaccine authorisation from the medicines regulators is based on data from a randomised, placebo controlled trial in 25 000 adults aged over 60 in 17 countries. 

The study is ongoing and will be used to evaluate the efficacy of a single vaccine dose over multiple seasons, the need for re-vaccination, and the vaccine’s safety profile. GSK is also carrying out a clinical trial that aims to expand the population who may benefit from RSV vaccine to adults aged 50-59, including those with underlying comorbidities, and results are expected this year.

Andrew Pollard, director of the Oxford Vaccine Group, which is involved in research into RSV, told The BMJ, “RSV is a major contributor to winter pressures in the NHS, usually just prior to the influenza season, with up to 30 000 hospitalisations in infants every year in the UK. The virus also precipitates admissions among frail and elderly adults: the true figure is not certain, but some studies have suggested that the numbers are of a similar magnitude to influenza, at least in some seasons.

“The arrival of new vaccines for adults and interventions to protect babies—maternal vaccination in pregnancy or monoclonal antibodies given at birth—could significantly ease the impact of this virus in the years ahead.”

(from an article in the BMJ: https://www.bmj.com/content/381/bmj.p978)

See the official insert of this vaccine here.

GSK press release: https://tinyurl.com/39j479dh

09 Feb 2014 – Pfizer’s RSV vaccine, Abrysvo is now available from us as a private vaccination.

This is the first and only RSV vaccine approved for pregnant women to help lower their babies’ risk of RSV from birth to 6 months.

Maternal immunisation refers to the process of vaccinating a pregnant woman so protective antibodies can be passed to the baby through the placenta before birth.

Get vaccinated during weeks 28 through 36 of your pregnancy (i.e., 32 weeks and zero days’ through 36 weeks and 6 days’ gestation) so you can pass RSV protection to your baby.  If possible, give two weeks interval between the whooping cough and RSV vaccinations.

This vaccine is fully authorised in the UK (see the official insert below).  The NHS is likely to start a national maternal and/or infant RSV vaccination programme(s) in autumn 2024 or later, however there is no fixed plan yet (see JCVI minutes from June 2023).

• Nearly 50% of all RSV hospitalisations during the first year occur during the first 3 months of life.
• 75-80% of hospitalisations due to RSV happened during the first 6 months of life.
• Abrysvo significantly reduced the risk of severe RSV in infants up to 6 months.

Currently, there is no RSV vaccination available which can be given to children, for routine NHS or private use.

See the UK official insert of this vaccine here: https://www.medicines.org.uk/emc/files/pil.15309.pdf

Estimated annual age-specific incidence of shingles per 100,000 per year in the immunocompetent population in England and Wales (population 2007). Data taken from van Hoek et al., 2009.

Estimated percentage developing Post Herpetic Neuralgia (PHN) by age group in the immunocompetent population in England and Wales (population 2007). Data taken from van Hoek et al., 2009.

Ref: The Green Book, Feb 2019

We also offer vaccinations with the new non-live shingles vaccine (£220 per dose inclusive – 2x doses required 2-6 months apart).

For more information, please see our shingles vaccination page here.

Price per dose: £440 for the full course inclusive (the new non-live shingles vaccine)
Number of doses for primary course: 2
Minimum dose intervals: 2
Age: 18+
When a booster dose given (in years): Not required

Prices: £35

Circadian rhythms regulate our sleep patterns and need time to adjust to changes in local time (usually about one day per time zone crossed). Westward travel may be better tolerated than eastward travel but problems occur when travelling in both directions. The effects of jet lag include – sleep disturbance, loss of appetite, nausea and sometimes vomiting, bowel changes (e.g. constipation), general malaise, tiredness and poor concentration.

After arrival hypnotics (sleeping tablets) have been shown to help with jet lag.

Notes: For more info visit: https://wwwnc.cdc.gov/travel/yellowbook/2018/the-pre-travel-consultation/jet-lag

Price per dose: £60 

Age: 1 year+

Ticks can transmit Lyme disease, which can be treated by antibiotics, whereas there is no specific treatment for TBE. To help protect against TBE, vaccination should be considered for all travellers at risk.

See the TBE vaccine's dosing schedule here.

Price per dose: £41
Number of doses for primary course: 3
Minimum dose intervals: –
Age: 2+*
When a booster dose given (in years): 3

Public Health England’s Green Book Typhoid Chapter 33 recommends that children between 12 months and 2 years should be immunised with the typhoid injectable vaccine if the risk of typhoid at their destination is high, e.g. those visiting friend and family in south east Asia for 4 weeks or more.

For more information and the vaccine schedules see here.

Price per dose: £41 (same price as typhoid injection vaccine)
Number of doses for primary course: 1
Minimum dose intervals: –
Age: 5+
When a booster dose given (in years): 3

Price per dose: £100
Number of doses for primary course: 1
Minimum dose intervals: –
Age: 3+
When a booster dose given (in years): Not required

Usually required for US visa clearance or visiting a newborn  

Repevax is a 4 in 1 vaccine which contains: Diphtheria, Tetanus, Pertussis (acellular) and Poliomyelitis (inactivated).  See the vaccine official insert here. 

There is currently no single whooping cough (pertussis) OR a 3 in 1 (tetanus, diphtheria, and whooping cough - Tdap) available in the UK. 

This is Tdap equivalent in the UK.

There have been large outbreaks of pertussis, also known as whooping cough, affecting several countries in recent years. This includes the UK, Australia, Canada and USA. Duration of protection from pertussis vaccine, or from having had the disease, is relatively short-lived. It is unlikely to be more than 10 years and may be less.

The policy in the UK is to vaccinate the pregnant woman in late pregnancy. The antibodies against pertussis which she produces will cross the placenta to help protect the baby.

In some countries, an approach known as ‘cocooning’ is used. This involves vaccinating all those in close contact with the baby – for example partners, spouses, immediate family and grandparents.

Price per dose: £70
Number of doses for primary course: 1
Minimum dose intervals: –
Age: 9 month+
When a booster dose given (in years): Not required

Do I need a certificate if my flight transits through a country with risk of yellow fever transmission?

Check individual country recommendations for up to date advice. It should be noted that some countries require proof of vaccination from all travellers.

A four week minimum interval period should be observed between the administration of these two vaccines. Yellow Fever and MMR should not be administered on the same day.

For more information and the vaccine schedules see here.

Price per dose: £30
Number of doses for primary course: –
Minimum dose intervals: –
Age: –
When a booster dose given (in years): –

We issue medical letter of exemption from the requirement for an International Certificate of Vaccination or Prophylaxis (ICVP) when appropriate / required – See here for more information: https://nathnacyfzone.org.uk/factsheet/6/medical-letter-of-exemption

Can a lost certificate be reissued?

Re-issuing a certificate is permissible if you have records of the dates and batch numbers from when the vaccine was administered. If not, then the only legally acceptable approach to satisfy immigration authorities is to repeat the vaccination.