These recommendations are based on government policy as discussed in Immunisation against infectious disease (the 'Green Book'), published by the Department of Health (DH) [DH, 2006d; DH, 2008a]. 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.
• All girls and young women up to 18 years of age will be offered HPV vaccination to protect against the future risk of cervical cancer, either as part of an ongoing immunization programme or as part of a catch-up campaign. The objective is to provide three doses of HPV vaccine to females before they reach an age when the risk of HPV infection increases and they are at subsequent risk of cervical cancer [DH, 2008b; DH, 2008c; MHRA, 2010]. It is estimated that:
• Up to 70% of cases of cervical cancer might be avoided.
• Four hundred lives a year may be saved.

These are pragmatic recommendations that represent good clinical practice.

• 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; DH, 2008a].

• 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 to start any course of immunisation again' [DH, 2006b]. This applies to vaccination for diphtheria, tetanus, pertussis, poliomyelitis, Haemophilus influenzae, measles, mumps, and rubella, and human papillomavirus.
• However, children have passed the period of most risk for pneumococcal at 10 years and meningococcal disease at 25 years, and do not require full immunization [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; DH, 2008a].

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].
• Over 1 year of age, either the deltoid muscle or the anterior aspect of the thigh can be used for administration.
• The deltoid muscle is preferred for most people as it is convenient, providing easy access.
• The gluteal muscle should be avoided, however. It is unlikely the needle will 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.