UK adult + occupational immunisation
JCVI-advised schedule operationalised via the UKHSA Green Book. Occupational vaccinations under COSHH 2002 + Green Book Chapter 12. Devolved delivery — broadly UK-wide, operationalised per nation.
RSV programme expansion — 1 April 2026
From 1 April 2026 the older-adult RSV programme expands to ≥80 with no upper age limit, plus all residents in care homes for older adults regardless of age. The 75-79 routine cohort remains. Spring 2026 co-administration with COVID-19 permitted.
UK ↔ US key divergences (8)
- ▸Adult booster: UK Td/IPV (Revaxis), no routine adult Tdap — vs US Tdap every 10 years
- ▸Pertussis adult: only in pregnancy (Tdap/Adacel from 16wk) — vs US broader Tdap
- ▸HPV: UK single dose since 2023 — vs US 2-3 doses
- ▸Shingles: phased Shingrix age cohorts — vs US universal 50+
- ▸BCG: UK uses occupational BCG for at-risk HCW — vs US does not routinely use BCG
- ▸Pneumococcal: UK PPV23 at 65 (PCV20 transition) — vs US PCV15/20/21 at 50+
- ▸RSV: UK 75 + pregnancy 28wk (Abrysvo) — vs US 75+ universal/60-74 risk + maternal Abrysvo 32-36wk
- ▸Welders pneumococcal: UK JCVI occupational indication — US less emphasised
Occupational vaccines (Green Book Chapter 12)
RSV (respiratory syncytial virus)
Abrysvo (Pfizer)
Trigger: age 75+ · age 75 plus routine · expanded 2026 04 01 to age 80 plus no upper limit · care home residents any age
Schedule
Single dose. 75-79 routine since Sept 2024. From 1 April 2026: expanded to ≥80 with NO upper age limit + all residents in care homes for older adults (regardless of age). Co-administration with COVID-19 spring 2026 campaign permitted.
Green Book Chapter 27a (RSV); JCVI advice 16 July 2025; expansion letter Jan 2026; effective 1 April 2026
Pneumococcal
PCV13 (children to 10) then PPV23 (from age 2)
Trigger: age 2+ · asplenia or splenic dysfunction · chronic heart lung liver kidney disease · diabetes · immunosuppression · cochlear implant · CSF leak · complement disorders
Schedule
At-risk groups: PPV23 (revaccination every 5 years only for asplenia/CKD/immunosuppressed). Occupational: welders + metal-fume exposure now an at-risk indication (JCVI).
Green Book Chapter 25; JCVI welders advice
Influenza (inactivated)
Trigger: · pregnancy · clinical risk group · carer · frontline health social care worker
Schedule
Annual flu vaccine for pregnant women (any stage), clinical risk groups, carers, and frontline health/social care workers (occupational — employer-provided).
Green Book Chapter 19
MMR (measles, mumps, rubella)
Trigger: · no evidence of 2 doses or immunity
Schedule
2 doses (≥1 month apart) for any adult without documented 2 doses or immunity. Occupational priority: healthcare/laboratory + education staff. UK measles resurgence — active catch-up.
Green Book Chapter 21 (MMR) + Chapter 12 (HCW)
Hepatitis B
Engerix B / HBvaxPRO / Fendrix
Trigger: · occupational exposure blood body fluids · HCW · lab staff · renal dialysis · PWID · MSM · household sexual contact HBV
Schedule
Occupational HBV programme for HCW/lab/exposure-prone procedures: 3-dose (0,1,6) or accelerated; post-vaccination anti-HBs check (≥10 mIU/mL adequate). Employer-provided under COSHH.
Green Book Chapter 18 (Hepatitis B) + Chapter 12 (HCW)
Hepatitis A
Trigger: · occupational sewage lab · travel endemic · MSM · PWID · chronic liver disease · haemophilia
Schedule
At-risk: sewage workers, lab staff handling HAV, travellers to endemic areas, MSM, PWID, chronic liver disease.
Green Book Chapter 17 (Hepatitis A)
Meningococcal B
Bexsero / Trumenba
Trigger: · asplenia splenic dysfunction · complement deficiency · complement inhibitor eculizumab ravulizumab · lab workers handling meningococcus
Schedule
At-risk only in adults: asplenia, complement deficiency, complement-inhibitor therapy, and laboratory staff who handle Neisseria meningitidis.
Green Book Chapter 22
Varicella (chickenpox)
Varivax / Varilrix (live)
Trigger: · seronegative HCW · seronegative close contact of immunocompromised
Schedule
2 doses for non-immune (seronegative) healthcare workers + non-immune close contacts of immunocompromised patients. Live vaccine — contraindicated in pregnancy/immunosuppression.
Green Book Chapter 34 (Varicella) + Chapter 12
BCG (tuberculosis)
BCG (live, intradermal)
Trigger: · unvaccinated tuberculin negative HCW with TB patient contact · lab staff handling TB · occupational high TB exposure
Schedule
UK offers occupational BCG to unvaccinated, tuberculin-negative HCW/lab staff with potential TB exposure (NOT routine in US). Single intradermal dose.
Green Book Chapter 32 (Tuberculosis/BCG) + Chapter 12
Pregnancy programme
RSV (maternal — infant protection)
Abrysvo (Pfizer)
Single dose from 28 weeks gestation in every pregnancy (protects infant via transplacental antibody).
Green Book Chapter 27a; maternal RSV programme Sept 2024
Influenza (inactivated)
Annual flu vaccine for pregnant women (any stage), clinical risk groups, carers, and frontline health/social care workers (occupational — employer-provided).
Green Book Chapter 19
Pertussis (whooping cough) in pregnancy
Tdap — Adacel (or Boostrix-IPV)
Single dose from 16 weeks gestation (ideally before 32 weeks) every pregnancy — infant protection. NOTE: pregnancy is the main UK adult pertussis indication (no routine non-pregnant adult Tdap).
Green Book Chapter 24 (Pertussis); maternal programme
Age-based programmes
Shingles (herpes zoster)
Shingrix (recombinant, 2 doses)
2 doses Shingrix (0, then 2-6 months; up to 12 months). Phased age expansion (65 and 70 cohorts) toward routine 60-80 over time. Replaced Zostavax (live) — Shingrix non-live.
Green Book Chapter 28a (Shingles); updated programme from 1 Sept 2025
Shingles (herpes zoster)
Shingrix (recombinant, 2 doses)
Severely immunosuppressed adults 18+ eligible for Shingrix (non-live, safe in immunosuppression unlike old Zostavax).
Green Book Chapter 28a
Pneumococcal
PPV23 (Pneumovax 23); PCV20 (Prevenar 20) once PPV23 stock exhausted
Single dose PPV23 at 65 (one-off, not routinely repeated). Transition to PCV20 underway as PPV23 stock is exhausted.
Green Book Chapter 25 (Pneumococcal)
Influenza (inactivated)
Annual inactivated influenza vaccine (aQIV adjuvanted or cell-based preferred 65+).
Green Book Chapter 19 (Influenza); annual flu letter
Tetanus / diphtheria / polio (Td/IPV)
Revaxis (Td/IPV)
UK uses Td/IPV (Revaxis) for adult boosters — NOT US-style Tdap. 5 doses confer lifelong protection. Boosters for tetanus-prone wounds or incomplete history; teenage booster at 14 (school Year 9).
US difference: US gives Tdap booster every 10 years; UK does NOT routinely booster non-pregnant adults beyond the 5-dose course.
Green Book Chapters 30 (Tetanus), 15 (Diphtheria), 26 (Polio)
HPV (human papillomavirus)
Gardasil 9
SINGLE dose (UK moved from 2 doses to 1 dose, Sept 2023) for immunocompetent under 25. Routine school Year 8 (12-13); catch-up to 25th birthday if eligible and missed.
US difference: US ACIP still uses 2-3 doses; UK is single-dose since 2023.
Green Book Chapter 18a (HPV); single-dose from Sept 2023
Risk-based / other indications
COVID-19 (seasonal)
Seasonal boosters per JCVI advice each campaign (cohorts vary by season — typically 75+, immunosuppressed, older-adult care home residents). NOT universal.
Green Book Chapter 14a (COVID-19); JCVI seasonal advice
HPV (human papillomavirus)
Gardasil 9MSM up to 45 offered HPV via sexual health/GUM services (immunocompetent: doses per current guidance; immunocompromised/HIV: 3 doses).
Green Book Chapter 18a
Meningococcal ACWY
MenACWY (Nimenrix/Menveo)New university entrants <25 (freshers); asplenia/complement disorders; travel to meningitis belt/Hajj (Saudi visa requirement).
Green Book Chapter 22 (Meningococcal)
Devolved implementation
Schedule is JCVI-advised and broadly UK-wide, but delivered by: NHS England + UKHSA (England), NHS Scotland + Public Health Scotland (Scotland), NHS Wales + Public Health Wales (Wales), HSC + Public Health Agency (Northern Ireland). Rollout cohorts (esp. shingles/RSV catch-up) and operational detail may differ by nation — confirm against the relevant nation's current schedule.
Verification transparency
Verified (UKHSA Green Book Jan 2026 + sanity checks)
- ●RSV — programme EXPANDED from 1 April 2026 to ≥80 + care-home residents (any age) with NO upper limit; 75-79 routine remains; pregnancy 28wk Abrysvo (sanity-check 2026-05-30)
- ●Shingles Shingrix 65/70-79 + immunosuppressed 18+
- ●Pneumococcal PPV23 65 (PCV20 transition)
- ●Pertussis pregnancy Tdap/Adacel from 16wk
- ●Td/IPV Revaxis
- ●HPV Gardasil 9 single dose
- ●Influenza 65+/pregnancy/risk
To re-verify at clinical use
- ●COVID-19 seasonal cohorts (JCVI changes each season)
- ●MSM HPV upper age
- ●occupational BCG indications detail