27 Jul 2022
The UK Heath Security Agency (UKHSA) has announced poliovirus (polio) has been found in sewage samples collected from the London Beckton Sewage Treatment Works. The monitoring of sewage is a routine way of detecting the virus in the community and current levels suggest there has been some spread between closely-linked people in north and north east London.
NHSE is also running a campaign focussed on childhood immunisations in general, with a lot of focus on MMR.
Clinicians are reminded to check the vaccination status for their young patients.
The polio vaccine is part of the NHS routine childhood vaccination schedule. The best way to prevent polio and other serious illnesses like diphtheria, measles, mumps and rubella is to make sure you are up to date with your vaccinations.
A UKHSA investigation is underway to protect the public, who are urged to ensure polio vaccines are up to date, especially parents of young children who may have missed an immunisation opportunity.
It’s given when a child is:
- 8, 12 and 16 weeks old as part of the 6-in-1 vaccine
- 3 years and 4 months old as part of the 4-in-1 (DTaP/IPV) pre-school booster
- 14 years old as part of the 3-in-1 (Td/IPV) teenage booster
You need to have all of these vaccinations to be fully vaccinated against polio. You can have a polio vaccination at any point if you’ve never had one before.
You should also get vaccinated even if you’ve had polio before as it protects against different types of polio.
Talking points for childhood immunisations
What vaccinations can children get?
Children in the UK are offered 18 vaccinations before they turn 18 to protect them from diseases such as measles and meningitis.
A full list of vaccinations for under 18s is available at the end of this document.
How does my child get vaccinated?
You’ll usually be contacted by your GP surgery when your child is due for a routine vaccination. This could be a letter, text message, phone call or email.
If you know your child is due for a vaccination, it’s best to speak to your GP surgery to book the appointment. You do not need to wait to hear from them.
Your appointment could be at your GP surgery or a local child health clinic.
Your baby can still have their vaccinations if:
- they have a minor illness without a high temperature – such as a cold
- they have allergies, asthma, eczema or food intolerances
- they were born prematurely
What happens after vaccination?
Your baby or child may cry for a little while after a vaccination, but they should feel better after a cuddle.
Sometimes the area where the needle goes in can be sore and red for 2 to 3 days. This should go away on its own.
Some vaccines might sometimes cause mild side effects that will not last long – some children may feel a bit unwell and have a sore arm for 2 or 3 days.
Some children may also develop a high temperature (fever). If this happens make sure your child isn’t wearing too many layers, give them plenty to drink and liquid paracetamol or ibuprofen for children to bring their temperature down.
How can I find if my child has been vaccinated or not?
If you’re unsure whether your child has missed a vaccination appointment, you can consult their Personal Child Health Record,(the red book). If you don’t know where it is, that’s not a problem, you can ask your GP practice.
Why vaccination is safe and important
Vaccines are the most effective way to prevent infectious diseases.
They protect you and your child from many serious and potentially deadly diseases and protect other people in your community by helping to stop diseases spreading to people who cannot have vaccines.
All vaccines and medicine undergo rigorous safety testing by the UK’s independent regulator before being introduced and they’re also constantly monitored for side effects after being introduced.
Vaccine can reduce or even get rid of some diseases in a population – if enough people are vaccinated.
It’s safe to give children several vaccines at a time to reduce the amount of injections they need; they do not overload or weaken the immune system.
Vaccines don’t contain any ingredients that cause harm in such small amounts – but please do speak to your doctor if you have any known allergies such as eggs or gelatine.
Vaccines, including the MMR vaccine, do not cause autism. Numerous studies have found no evidence of a link between the MMR vaccine and autism.
It’s important to be aware that anti-vaccine stories and myths are often spread online through social media. If you have any questions about any vaccine, you should visit the NHS website or speak to your GP or health visitor.
Vaccination tips for the day
There are many things you can do to make your child’s vaccination go as smoothly as possible:
- remember to take your personal child health record (PCHR) – in England this is usually known as the “red book”. If you don’t remember where it is, don’t worry, your GP will have a record of your child’s vaccinations.
- call the practice or clinic to let them know if someone else is taking your child for vaccinations – or give the person a letter with your contact details
- dress for your appointment. Babies under 12 months have injections in the thigh whereas toddlers and older children have injections in the arm – it’s helpful if your child is wearing something that is easy to remove.
- try to stay calm during the vaccination – it’s natural to worry, but it might make your child anxious and restless. You’re taking a positive step to protect your child from potentially serious illness
- let your child know what’s going to happen in simple language – for example, “you may feel a sharp scratch that will go away very fast”
- hold your child on your knee during the injection – if you’re worried about seeing injections you could ask a nurse or another member of staff to hold them for you
- give yourself plenty of time to get to your appointment so you and your child aren’t feeling rushed or anxious
Your doctor or nurse will be happy to answer any questions you might have about vaccination.
Extra vaccines for at risk babies and children
Some children might need more vaccines to give them some extra protection. Examples include hepatitis B vaccines for babies born to parents who have hepatitis B and BCG tuberculosis vaccines for babies born in areas of the country where there are high numbers of TB (tuberculosis) cases.
These vaccines are often given at birth and may be followed up with more doses. They are all safe for your baby to take and it’s really important for you to attend your appointments to ensure your child is not put at risk.
Your GP or specialist clinician will let you know what vaccinations your child requires and how to book.
Full list of vaccinations for children under 18
| Age | Vaccines |
| 8 weeks | 6-in-1 vaccine |
| Rotavirus vaccine | |
| MenB | |
| 12 weeks | 6-in-1 vaccine (2nd dose) |
| Pneumococcal (PCV) vaccine | |
| Rotavirus vaccine (2nd dose) | |
| 16 weeks | 6-in-1 vaccine (3rd dose) |
| MenB (2nd dose) | |
| 1 year | Hib/MenC (1st dose) |
| MMR (1st dose) | |
| Pneumococcal (PCV) vaccine (2nd dose) | |
| MenB (3rd dose) | |
| 2 to 10 years | Flu vaccine (every year) |
| 3 years and 4 months | MMR (2nd dose) |
| 4-in-1 pre-school booster | |
| 5 to 15 years | COVID-19 vaccine (1st and 2nd dose) |
| 12 to 13 years | HPV vaccine |
| 14 years | 3-in-1 teenage booster |
| MenACWY | |
| 16 years and over | COVID-19 vaccine (1st, 2nd and booster dose) |
Taken from
https://www.nhs.uk/conditions/vaccinations/nhs-vaccinations-and-when-to-have-them/
Useful links
A range of patient resources on routine childhood immunisations in several different languages is available at the website below and can be ordered for free. Note, you may need to sign up to order.
https://www.healthpublications.gov.uk/Home.html
Why vaccination is safe and important – NHS (www.nhs.uk)
WHO: How do vaccines work? – YouTube
Doctors of the World – Vaccine Confidence Toolkit
Here you can find Useful resources from NEL Clinical Effectiveness Group (CEG) including Updated Child Imms Searches S1 and how to access the step-by-step User Guide for CEG’s new child imms call/recall tool, FAQs and demo videos.
Resources
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Check your child’s vaccination record for the polio vaccine
The best way to prevent polio is to make sure you and your child are up to date with your vaccinations. The polio vaccine is given as part of a combined jab to babies, toddlers, and teenagers as part of the NHS routine childhood vaccination schedule.
Check your child’s red book or speak to your GP if you’re unsure if your child has had this vaccine. It’s not too late to get caught up. Make an appointment with your GP surgery or local child health clinic as soon as you can.
Other useful info and resources:
Leaflets for parents:
- Primary course Immunisations at one year of age – GOV.UK (www.gov.uk) Product code 2022QG1EN
- Pre-school booster Pre-school vaccinations: guide to vaccinations from 2 to 5 years – GOV.UK (www.gov.uk) Product code 3197560P
- Teenage booster Immunisations for young people – GOV.UK (www.gov.uk) Product code 2902598B
Resources for recent migrants:
- UKHSA have developed a tool to help health professionals check immunisation status of new entrants into the UK: UK and international immunisation schedules comparison tool
- Migrant health guide immunisation section: Immunisation: migrant health guide – GOV.UK (www.gov.uk)
- Immunisation information for migrants: Immunisation information for migrants – GOV.UK (www.gov.uk)
Stickers:
- Immunisation stickers bear design: https://www.healthpublications.gov.uk/ViewArticle.html?sp=Simmunisationstickers5yearstoadultbeardesign
- Immunisation stickers butterfly design: https://www.healthpublications.gov.uk/ViewArticle.html?sp=Simmunisationstickers5yearstoadultbutterflydesign
General useful info:
- Polio Green Book chapter: Polio: the green book, chapter 26 – GOV.UK (www.gov.uk)
NHS webpages:
- Polio – NHS (www.nhs.uk)
- NHS vaccinations and when to have them
- 6-in-1 vaccine
- Complete routine immunisation schedule: Complete routine immunisation schedule – GOV.UK (www.gov.uk)
- This algorithm is aimed at helping health professionals bring individuals up to date with the UK schedule according to their age: Vaccination of individuals with uncertain or incomplete immunisation status (publishing.service.gov.uk)
- Vaccine coverage statistics:
- Vaccine coverage for routine programme in children aged 1, 2 and 5 years can be found here (Quarterly COVER data – Source: UKHSA): Vaccine uptake guidance and the latest coverage data – GOV.UK (www.gov.uk)
- Vaccine coverage for school-aged Td/IPV immunisation programme – 2020/21 academic year (Source: UKHSA): School leaver booster (Td/IPV): vaccine coverage estimates – GOV.UK (www.gov.uk)
Q&A
When is the polio vaccine offered?
The polio vaccine is given when your child is:
- 8, 12 and 16 weeks old as part of the 6-in-1 vaccine
- 3 years and 4 months old as part of the 4-in-1 (DTaP/IPV) pre-school booster
- 14 years old as part of the 3-in-1 (Td/IPV) teenage booster
You need all 5 of these vaccinations to be fully vaccinated against polio.
What does the 6-in-1 vaccine protect against?
The 6-in-1 is given as a single injection to protect your baby against 6 serious childhood conditions:
- diphtheria
- hepatitis B
- Hib (Haemophilus influenzae type b)
- polio
- tetanus
- whooping cough (pertussis)
For more information visit: https://www.nhs.uk/conditions/vaccinations/6-in-1-infant-vaccine/
What does the 4-in-1 pre-school booster protect against?
The 4-in-1 pre-school booster vaccine is offered to children to boost their protection against 4 different serious conditions:
- diphtheria
- tetanus
- whooping cough
- polio
For more information, visit: https://www.nhs.uk/conditions/vaccinations/4-in-1-pre-school-dtap-ipv-booster/
What does the 3-in-1 teenage booster protect against?
The teenage booster, also known as the 3-in-1 or the Td/IPV vaccine, is given to boost protection against 3 separate diseases: tetanus, diphtheria and polio.
For more information, visit: https://www.nhs.uk/conditions/vaccinations/3-in-1-booster-questions-answers/
I am an adult and haven’t been vaccinated, is it too late?
Adults are eligible to have the complete course of 5 doses. You can have a polio vaccination at any point for free on the NHS if you’ve never had a vaccination for polio or have not completed the course of 5 doses. Contact your GP to book an appointment.
Do I need the vaccine if I’ve already had polio?
Yes, you should also get vaccinated even if you’ve had polio before as it protects against different types of polio.
Can you just get vaccinated with polio vaccine on its own if you didn’t get it through routine programme?
You will be caught up using the appropriate combination vaccine for your age and vaccination history.
Can I get polio from the polio part of the vaccine?
The combined vaccines contain dead (inactivated) polio virus, which cannot cause polio.
I have seen on the news that there has been an outbreak of polio. What is the current situation?
The UK Heath Security Agency (UKHSA), working with the Medicines & Healthcare products Regulatory Agency (MHRA), has found poliovirus in sewage samples collected from the London Beckton Sewage Treatment Works.
As part of routine surveillance, it is normal for 1 to 3 ‘live-vaccine like’ polioviruses to be detected each year in UK sewage samples but these have always been one-off findings that were not detected again. These previous detections occurred when an individual vaccinated overseas with the live oral polio vaccine (OPV) returned or travelled to the UK and briefly ‘shed’ traces of the vaccine-like poliovirus in their faeces.
Investigations are underway after several closely related viruses were found in sewage samples taken between February and May. The virus has continued to evolve and is now classified as a ‘live vaccine-derived’ poliovirus type 2 (VDPV2), which on rare occasions can cause serious illness, such as paralysis, in people who are not fully vaccinated.
The detection of a VDPV2 suggests it is likely there has been some spread between closely linked individuals in London and that they are now shedding the type 2 poliovirus strain in their faeces. The virus has only been detected in sewage samples and no associated cases of paralysis have been reported but investigations will aim to establish if any community transmission is occurring.
How many people do we estimate have it?
Vaccine-derived poliovirus has only been identified in sewage samples collected from the London Beckton Sewage Treatment Works. No cases have been identified.
What should people do?
The risk to the public overall is extremely low. However, if you or your child are not up to date with your polio vaccinations, please contact your GP. You can check if you or your child have had the vaccine through the red book, or by contacting your GP practice.
The best way to prevent polio is to make sure you and your child are up to date with your vaccinations
What types of polio vaccine are there and how are they used?
There are two types of polio vaccine – inactivated polio vaccine (IPV) and oral polio vaccine (OPV).
IPV is the inactivated polio vaccine which is injectable and is what we have used in the UK since 2004.
In countries where polio is still circulating, OPV, the oral polio vaccine (given by mouth) is used because it is better at controlling outbreaks. OPV contains a weakened live virus that mimics natural infection by growing in the gut and can be shed in faeces for a few weeks after people are vaccinated.
Because OPV generates an immune response in the gut it is very good at stopping the spread of polio, and it has been a very important tool in the global effort to eradicate polio.
What are the symptoms of polio?
Most people with polio won’t have any symptoms and will fight off the infection without even realising they were infected. A small number of people will experience a flu-like illness 3 to 21 days after they’re infected.
Symptoms can include:
- a high temperature (fever) of 38C (100.4F) or above
- a sore throat
- a headache
- abdominal (tummy) pain
- aching muscles
- feeling and being sick
These symptoms will usually pass within about a week without any medical intervention.
In a small number of cases, between 1 in 100 to 1 in 1000 infections, the polio virus attacks the nerves in the spine and base of the brain. This can cause paralysis, usually in the legs, that develops over hours or days. If the breathing muscles are affected, it can be life threatening.
If you or your child is experiencing unusual symptoms that could be the beginning of paralysis you should always seek medical advice immediately. Symptoms include rapid onset of weakness in a limb which will be flaccid (or floppy). The weakness most often involves the legs, but sometimes affects the muscles of the head and neck or breathing.
After paralytic polio, movement will often slowly return over the next few weeks and months, but many people are left with persistent problems. If you are experiencing these symptoms you should consult a health professional immediately.