Vaccines and immunisation: resources to support clinical decisions

SPS resources

SPS has a variety of advice from handling temperature excursions to travel health and vaccines.

Temperature excursions

Most vaccines require refrigeration between 2 and 8⁰C during their shelf life. See our article on Managing temperature excursions (SPS page) for actions to take if vaccines are exposed to temperatures outside this range.

Use our Refrigerated medicines stability tool (SPS page) for advice on whether refrigerated medicines can or can’t be used after exposure to out-of-range temperatures. To find information for a specific vaccine, search by the product or generic name. You can add the information to create a printable list.

Vaccines and breastfeeding

All vaccinations, including live vaccines, can be given during breastfeeding. The only exception is yellow fever vaccine which is not recommended. Using vaccines during breastfeeding (SPS page) provides further information.

Travel vaccine resources

Resources to help healthcare professionals find information regarding medicines and travel can be found at Travel health: resources to support clinical decisions (SPS page).

Support for organisations

Vaccine Group Direction (VGD) is the legal mechanism to support the administration of UK licensed vaccines within nationally commissioned vaccination programmes. Understanding Vaccine Group Directions (VGDs) (SPS page) explains what VGDs are, how they differ from Patient Group Directions (PGDs) and who can work under a VGD.

Seasonal influenza vaccination and occupational health services (SPS page) gives advice on medicines mechanisms for the administration of influenza vaccinations to healthcare staff.

Handling of COVID-19 vaccines (SPS page) provides resources useful to organisations involved in ongoing COVID-19 vaccination programmes.

Other resources

In addition to our own resources, we recommend the following resources that are free to access.

Local formulary or guidelines

Your local Area Prescribing Committee, Medicines Management Group or similar body may have relevant guidelines or documents on their website. For example, formulary status of medicines outside the national vaccination programme, supply processes, or PGDs for local use.

In secondary care, consult Trust policies and guidance.

NHS website

The NHS website has information on vaccine-related topics such as:

• why and how to get vaccinated
• vaccinations recommended in people who are pregnant
• winter vaccinations
• information on children’s influenza vaccines and ingredients

To find the information you want, click on Health A to Z or use the search box.

NHS vaccinations

NHS vaccinations and when to have them is aimed at the public but is also useful for healthcare professionals. It summarises the NHS vaccination schedule by age and lists vaccines recommended during pregnancy.

For individual vaccines, the articles provide information such as:

• who should have it
• how many doses are required
• who cannot have it
• ingredients of note
• if it can be given at the same time as another vaccine
• common side effects
• length of immunity

Immunisation against infectious disease (Green Book)

The Green Book provides the latest information on vaccines and vaccination procedures for vaccine preventable diseases in the UK.

Each chapter opens as a PDF document; it is useful to familiarise yourself with the format. You can search within the PDF for key words or topics.

Make sure to look at the current version by opening individual chapters; the website also allows access to the complete 2006 edition of the book which is out of date.

The chapters are listed as two parts:

• principles, practices and procedures
• the diseases, vaccinations and vaccines

You may need to refer to multiple chapters when reviewing an individual.

For example, advising on a vaccine in immunocompromised individuals is covered by chapter 7 on immunisation of individuals with underlying medical conditions and the named vaccine chapter.

Other useful chapters include:

• storage, distribution and disposal of vaccines (chapter 3) includes handling spillages and disposing of expired or damaged vaccines
• contraindications and special considerations (chapter 6) includes dealing with a previous anaphylaxis to vaccines, live vaccines in people with immunodeficiency and using biologics

GOV.UK Immunisation

Immunisation provides links to practical advice such as:

• complete routine immunisation schedule which is updated to reflect changes to specific vaccine programmes
• vaccination of individuals with uncertain or incomplete immunisation and what to do
• UK and international immunisation schedules comparison tool to help ascertain what vaccines individuals moving to England from abroad have received in their previous country
• responding to vaccine errors for advice on how to respond to incidents such as storage errors, interruptions in the cold chain, and when to revaccinate

Summary of Product Characteristics (SmPCs)

SmPCs are available via the electronic Medicines Compendium and MHRA. They can be useful for answering questions relating to:

• contraindications (section 4.3)
• excipients (section 6.1)
• vaccine storage (section 6.4)

For information on the use of vaccines within national immunisation programmes, follow guidance in the Green Book or NHS resources.

Clinical Knowledge Summaries

There are several Clinical Knowledge Summaries (CKS) related to vaccines and immunisation.

These include:

• reducing the risk of human papillomavirus (HPV) and cervical cancer
• routine childhood vaccines summarised by age
• which pneumococcal vaccine to use, who should have them and who should be offered re-vaccination
• which influenza vaccine to use, who should have them and managing egg allergy
• which tetanus vaccine to use, who should have them and when to give booster doses

National Institute for Health and Care Excellence (NICE)

Relevant NICE Guidelines include:

• increasing the uptake of vaccines in the general population through routine schedules
• increasing the uptake of free influenza vaccines in people who are eligible

Further advice

If the information is not available on the SPS website or the information resources listed, or if your clinical scenario is complex, our Medicines Advice service (SPS page) may be able to help. This service is available for healthcare professionals working in NHS primary care (including community pharmacy) in England.

In secondary care, you may be able to seek advice from your Trust Medicines Information service or a directorate pharmacist.

Training resources

There are national standards describing the training that should be given to all practitioners engaging in any aspect of immunisation. This can be supported by short videos which provide a basic understanding of the immune system and how vaccines work.

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