These recommendations are based on government policy as discussed in Immunisation against Infectious Disease (the 'Green Book'), published by the Department of Health [DH, 2006d]. These guidelines are derived from the best current evidence encompassing immunological, epidemiological, and controlled studies.

• The diseases prevented by vaccines used in the Childhood Immunization Programme cause (or have caused in the past) extensive morbidity and mortality. In most cases, the incidence of these diseases has been greatly reduced by use of vaccines, and in some cases diseases have been virtually eradicated in the UK.
• The quality of evidence to support the use of vaccines depends largely on when the vaccine was introduced. The efficacy of vaccine components that have been in use for decades, for instance, is usually evident by the marked fall in incidence of the disease it protects against compared with the period prior to the vaccine's introduction. Newer vaccines are more likely to have evidence from controlled trials to support their effectiveness and safety. For further information, see individual diseases in Supporting evidence.
• Booster doses are necessary for most diseases to ensure an adequate antibody response and protection throughout childhood and into adulthood. Further booster doses of all vaccines are required except for PCV in healthy children (children at high risk may require some additional protection with pneumococcal polysaccharide vaccine).
• MMR vaccine can be given at any age over 1 year, but is usually left until the child is 13 months of age, to maximize protection when residual maternal antibodies are likely to have declined [DH, 2006j].

These are pragmatic recommendations that represent good clinical practice.

• Many parents find the process of having their children immunized distressing. Explaining the benefits of vaccination and giving reassurance about the limited nature of the adverse effects should help allay fears.
• CKS found no controlled trials that investigated the efficacy of paracetamol or ibuprofen in reducing pain or fever following vaccination.
• One systematic review, including a randomized controlled trial, found evidence that the prophylactic use of paracetamol or ibuprofen was effective in relieving post-vaccination symptoms in children receiving diphtheria-tetanus-whole pertussis (DTwP) vaccine [Manley and Taddio, 2007]. However, the review found no evidence that analgesia relieved adverse effects caused by diphtheria-tetanus-acellular pertussis vaccine (DTaP).
• As paracetamol and ibuprofen have been shown to reduce fever and pain in conditions such as the common cold and influenza [Eccles, 2006], it can be reasonably extrapolated that they may be effective in relieving these symptoms on an 'as required' basis after vaccination.

These recommendations are based on government policy as discussed in Immunisation against infectious disease (the 'Green Book'), published by the Department of Health [DH, 2006d].

• In the chapter entitled The UK immunisation programme, the 'Green Book' states that 'If any course of immunisation is interrupted, it should be resumed and completed as soon as possible. There is no need start any course of immunisation again' [DH, 2006b]. This applies to vaccination for diphtheria, tetanus, pertussis, poliomyelitis, H. influenzae, measles, mumps and rubella.
• Full immunization for pneumococcal and/or meningococcal disease is not required however, with a single booster dose providing adequate protection for children of this age group [DH, 2006a; DH, 2006k].

These are pragmatic recommendations as discussed in Immunisation against infectious disease (the 'Green Book'), published by the Department of Health [DH, 2006d].

These recommendations are based on good clinical practice and are consistent with recommendations given in the 'Green Book' [DH, 2006d].

• Getting consent before vaccination fulfils both a clinical function (to foster trust and cooperation with parents or guardians) and a legal function, namely to ensure that a person's right to autonomy has been addressed in order to prevent a charge of battery [Vaccine Administration Task Force, 2001].
• The site of administration depends on the child's age:
• The deltoid muscle or the anterior aspect of the thigh can be used for administration. However, the deltoid muscle is generally preferred for most children as it is convenient, providing easy access.
• The gluteal muscle should be avoided. The needle may not penetrate through adipose tissue into the muscle, and this may cause a poor immunological response to the vaccine. In addition, there is a risk of damage to underlying structures such as the sciatic nerve.