MenB (Meningococcal B) vaccine
Most cases of meningococcal disease
in the UK and Ireland are caused by group B meningococcal bacteria. A new MenB vaccine, called Bexsero®, is now being given free of charge to all babies in the UK at 2, 4 and 12 months of age. It is not yet freely available in Ireland. Find out more
MenC (Meningococcal C) vaccine
MenC containing vaccines in the UK and Irish immunisation schedules provides excellent protection against meningitis and septicaemia caused by group C meningococcal bacteria.
The MenC vaccination campaign was introduced in the UK in 1999 and in Ireland in 2000. Before the vaccine was routinely available group C meningococcal disease killed about 150 people in the UK every year.
Following vaccine introduction, cases of group C disease fell by over 90% in the age groups targeted for vaccination.
Since then case numbers have continued to fall and as a result of the ongoing vaccination programme disease incidence is now at a very low level. Who should be immunised with MenC vaccine?
Currently in England, Wales and Northern Ireland children have their first dose of MenC vaccine at 12-13 months of age as a combined Hib/MenC vaccine.*
A routine booster dose is being given at around 14 years of age (school years 9 or 10 in England and Wales and 11 in Northern Ireland) as a combined MenACWY vaccine at the same time as the current teenage Td/IPV booster. More information about the MenACWY vaccine
Prior to 1st July 2016 all UK infants received MenC vaccine at 3 months of age. However the Joint Committee on Vaccination and Immunisation (JCVI) made the decision to remove this dose. This dose was removed because the vaccination programme has worked so well that there are now very few cases of invasive MenC disease in the UK. Boosting protection against MenC in teenagers with the MenACWY vaccination programme is expected to sustain good protection amongst all age groups by reducing the transmission and spread of the bacteria amongst the population so the risk to infants will remain low into the future.*MENC VACCINATION IN SCOTLAND
Scottish children are currently immunised with MenC vaccine at 3 months of age with two booster doses, one at 12-13 months (Hib/MenC vaccine) and another at in school year S3 at around 14 years of age (MenACWY vaccine). The 3 month dose will be removed from the schedule from September 5th in keeping with JCVI recommendations.MENC VACCINATION IN IRELAND
In Ireland the MenC vaccination is given at 4 and 13 months with a booster at 12-13 years. The MenC booster is given as part of the school immunisation programme to children in their 1st year of second level school in the second or third term of the academic year.A catch up campaign to vaccinate first year university students in the UK will take place for a limited time.Information for under 25 year olds
Anyone in this age group who has not received any dose of the vaccine can arrange to be immunised by contacting their GP.Information for people without a functioning spleen
People with no spleen, with a disease or condition that stops their spleen from functioning properly and those who have complement disorders are at high risk of serious bacterial infection. People with the above medical conditions, may need extra meningococcal vaccinations and should contact their GP to discuss this. Are MenC containing vaccines safe?
How do MenC containing vaccines work?
- Yes, all MenC containing vaccines used in the routine immunisation schedule in the UK and Ireland have been proven to be safe and effective.
- It is never possible to be sure that a child will not react seriously to any medicine, vaccine or even food, but parents make decisions every day about the level of risk that is acceptable to them. The risk of severe allergic reaction such as anaphylaxis to any vaccine in the routine schedule is tiny. One study found no cases of anaphylaxis related to vaccines given as part of the ‘routine’ infant and preschool immunisation programme, despite over 5.5 million vaccines being delivered over the study period1. Although the risk of getting Group C meningococcal disease is not high, it outweighs any small risk from the vaccine.
- The MenC containing vaccine are not 'live' and cannot cause even a mild form of meningitis or septicaemia.
Who should not be given the MenC vaccine?
- Conjugate vaccines are made by linking a tiny fragment from the bacteria's sugar coat (polysaccharide) to a protein. Our immune systems respond much more strongly to proteins than to sugars, so conjugate vaccines trigger a long-lasting immune response, and are effective in babies as young as two months of age.
Is there a problem with 'multiple' vaccines?
- There are very few people who cannot receive meningococcal vaccines. People who have had a confirmed anaphylactic reaction (not just a sore arm or a mild temperature) to a previous dose of MenC vaccine or to any component of the MenC vaccine should not have it2 .
- Vaccination should be postponed in anyone who is ill with a high fever.
Some parents might be worried that having DTP, Hib, polio and MenC together will overload babies' immature immune systems.
- Trials showed that all of these vaccines are safe and effective when given together.
- Vaccines do not 'overload' the immune system3. In order to work, vaccines must bring on a response from the immune system, but everyday mishaps like scraped knees and sore throats place more of a demand on the immune system than the combination of MenC and all of the routine vaccinations for babies.
- Routine vaccinations are timed to protect babies when they need it most.
Although the MenC vaccine has been tremendously successful, it is important to remember that not all forms of meningitis and septicaemia are vaccine preventable and it is still important to be aware of the symptoms of meningitis and septicaemia
- Michel Erlewyn-Lajeunesse, Linda P Hunt, Paul T Heath, Adam Finn. Anaphylaxis as an adverse event following immunisation in the UK and Ireland. Arch Dis Child 2012;97:487–490. doi:10.1136/archdischild-488 2011-301163
- Department of Health. Immunisation against infectious disease. Chapter 22 Meningococcal. https://www.gov.uk/government/publications/meningococcal-the-green-book-chapter-22 (accessed April 2014).
- Offit PA, Offit PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR, Gellin BG, Landry S. Addressing parents' concerns: Do multiple vaccines overwhelm or weaken the infant's immune system? Pediatrics Jan 2002;109(1):124-9. http://pediatrics.aappublications.org/cgi/content/full/109/1/124 (accessed 17 May 2007)
Hib (Haemophilus Influenzae Type B) vaccine
A conjugate vaccine (made from a tiny fragment of the bacteria's sugar-coat attached to a protein) against Hib was introduced in the UK and Ireland in 1992, and provides long-lasting immunity. Since the introduction of the Hib vaccine, the incidence of meningitis cause by Haemophilus influenzae has been reduced by over 90%, across the UK and Ireland 1,2 .
Introduction of the conjugate Hib vaccine has also reduced carriage rates of the bacteria 3 . Before the vaccine was introduced, a large proportion of children under age 5 carried the bacteria. Now that vaccination is routine, carriage of the bacteria is much less common, and as a result protection is extended to the rest of the population, even those not immunised. This is called 'herd immunity'.
Is Hib vaccine safe?
Millions of doses given to children worldwide over more than a decade have established an excellent safety record. Adverse reactions are no more common than for other vaccines routinely given to babies and children. The Hib vaccine is not a live vaccine and cannot cause even a very mild form of the disease.
Who gets Hib vaccine?
Currently in the UK, the vaccine is offered to babies at 2, 3, and 4 months of age in the routine immunisation programme, with a Hib booster (given as combined Hib/MenC) offered at 12-13 months of age.
In addition, in the UK, Hib vaccine is recommended for older children and adults with certain immune deficiencies such as people with HIV or those without a functioning spleen (asplenics and hyposplenics), including people who have sickle cell disorder 4 .
Currently in Ireland, the vaccine is offered to babies at 2, 4 and 6 months of age in the routine immunisation programme, with a Hib booster dose offered at 12 months of age.
In addition to babies, in Ireland, Hib vaccine is recommended for all children under four years of age who have not previously had the vaccine and for anyone with malfunctioning or lack of spleen, sickle cell disease, HIV or other immunodeficiency, irrespective of how old they are 5 .
Is Hib still an important cause of meningitis?
The Hib vaccine is very effective, but no vaccine is 100% effective. It does not work as well in children with certain immune problems. In addition, a very small proportion of perfectly healthy children do not respond to the vaccine well enough to be protected against Hib meningitis. It is unusual for adults and older children to be susceptible to Hib infection, but cases are known to occur, particularly in hospitalised, sick and elderly patients. Illness caused by non-b types of Haemophilus influenzae
is also being monitored.
Immunisation has dramatically reduced cases of Hib meningitis, but in countries which have not introduced the vaccine, Hib is still a major cause of serious disease in children.
- JCVI Statement: Haemophilus influenzae type b (Hib) Disease and Hib Vaccine. Executive Summary. http://www.advisorybodies.doh.gov.uk/jcvi/hib.pdf (accessed 17 May 2007).
- Health Protection Surveillance Centre. Hib FAQs, How safe and effective is the Hib vaccine? http://www.immunisation.ie/en/HealthcareProfessionals/Hib/#howsafe (accessed May 2007).
- Frasch CE, Haemophilus influenzae Type b Conjugate and Combination Vaccines. 1995. Clin.Immunother. 4 (5):376-386
- Department of Health. Immunisation against infectious diseases. Chapter 16: Haemophilus influenzae type B (Hib) pages 127-135. Ed Salisbury D, Ramsay M and Noakes K. 2006. Third edition. TSO. http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Greenbook/DH_4097254 (accessed 17 May 2007).
- Immunisation Guidelines 2002.
http://www.ndsc.ie/hpsc/A-Z/VaccinePreventable/Vaccination/Guidance/ (accessed May 2007)
- Professional Letter- Chief Medical Officer (2003)2: Planned HIB vaccination catch-up campaign: further information Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Professionalletters/Chiefmedicalofficerletters/DH_4004833 (accessed 17 May 2007)
Pneumococcal vaccine in the UK
Currently two different vaccines are used in the UK, one in ther outine childhood immunisation schedule for all babies and the other for everyone over 65. These vaccines are also available to people with particular health conditions that increase their risk from pneumococcal infection. The single most important thing you can do to prevent pneumococcal meningitis is to make sure your children are up to date with their routine immunisations, and to have the immunisations you are eligible for.
Pneumococcal ‘conjugate’ vaccine (PCV)
The current vaccine in the childhood immunisation schedule, Prevenar13®(PCV13) can protect against severe infection caused by thirteen of themost common strains of pneumococcal bacteria. Conjugate vaccines areexplained in more detail in the box opposite.
- is routinely offered to all babies at 2, 4 and 12-13 months of age, within the routine childhood immunisation programme,
- is similar to the successful Hib and MenC vaccines, which are also conjugate vaccines,
- provides direct protection to those who are vaccinated. However, because the vaccine also reduces the number of people who are carrying and potentially transmitting the bacteria, people who are not vaccinated also benefit from indirect protection. This is called ‘herd’ immunity.
PCV13 was introduced in spring 2010 and directly replaced PCV7,which only provided protection against seven strains of pneumococcalbacteria. The change was made to provide broader coverage for childrenby protecting against six additional strains of bacteria.
Is this vaccine safe for my child?
Yes. The widespread use of PCV7 in over 100 countries, with over 300million doses distributed worldwide, established a solid safety record.Clinical trial data from studies involving more than 7000 children showthat PCV13 has a similar safety profile to PCV7.
What if my child has already received one or two doses of PCV7?
Children who have already received one or two doses of PCV7 cancomplete their vaccination course with PCV13 with no change to theroutine vaccination schedule.
Did PCV7 vaccine reduce cases of pneumococcal meningitis after it was introduced in 2006?
PCV7 was very successful at preventing the seven strains ofpneumococcal infection it covers. In the first two and a half yearsafter the introduction of PCV7, it is been estimated that 959 cases ofserious illness and 53 deaths due to invasive pneumococcal disease wereprevented2.
Meanwhile, as disease caused by the seven most common strainsdecreased, cases caused by other strains of pneumococcal bacteria hadbeen increasing3. Therefore, the vaccine was upgraded to provide broader protection.
There are over 90 strains of pneumococcal bacteria, but most strainsrarely cause disease. PCV13 covers the strains that account forapproximately 74% of all severe pneumococcal disease in young childrenin England and Wales1.
Severe pneumococcal disease in children aged under 5 caused by strains in Prevenar and Prevenar13
Pneumococcal ‘polysaccharide’ vaccine (PPV)4
Thisvaccine provides a level of short-term protection against seriouspneumococcal disease caused by the top 23 disease-causing types ofpneumococcal bacteria (see box opposite). This vaccine is offered toadults over the age of 65 and children over the age of 2 who havehealth conditions which put them at increased risk from pneumococcalinfection.
What health conditions increase the risk from pneumococcal infection?
Health conditions which increase the risk of infection include4:
- having no spleen, due to injury or disease, or a spleen that does not work properly as in sickle cell disorder, and coeliac disease;
- other immunodeficiency, whether inherited or acquired (e.g. HIV);
- immunosuppression as with cancer therapy or organ transplant;
- chronic disease of the heart, kidney or liver;
- chronic respiratory diseases, including, for example, asthma requiring repeated use of systemic steroids, chronic obstructive pulmonary disease;
- diabetes requiring insulin;
- people with or about to have cochlear implantation or other conditions where leakage of cerebrospinal fluid can occur (but vaccination must not delay cochlear implantation).
What protection is offered to people with 'at risk' health conditions?
People with at risk health conditions should be offered vaccinationwith PCV, PPV or both depending on their age and the condition theyhave.
In general the following applies to people with “at risk” health conditions*:
- Babies should be immunised according to the routine schedule followed by one dose of PPV after their second birthday,
- Children under 5 years of age, who haven’t previously been vaccinated should be offered PCV and then PPV after their second birthday,
- Children over 5 years of age and adults should be offered PPV if they haven’t already received this.
*People with an absent or damaged spleen, who are HIVpositive, receive bone marrow transplants or have chronic renal diseaseshould seek specialist advice as recommendations in these cases candiffer.
Children under 2 years of age with at risk conditions and who havealready had the full course of PCV7 are eligible for a PCV13vaccination.
Children who get severe pneumococcal disease
Any child under age 5 years who gets pneumococcal meningitis or othersevere pneumococcal disease will be followed up by their GP orpaediatrician, to check whether they have an ‘at-risk’ health condition5. These children should be offered PCV even if they have already had it. They may also be offered PPV.
ALL children who are under the age of 2 and have missedimmunisations are entitled to receive PCV and are entitled to receiveother routine immunisations up to age 10.
IMPORTANT: Vaccines cannot protect against all forms of meningitis
It is important to remember that although vaccinescan provide excellent protection, there are still some types ofmeningitis and septicaemia for which there are no vaccines. It isimportant to be aware of the symptoms of these diseases and to seekmedical help immediately if you suspect that someone has meningitis orsepticaemia.
- Kaye P, Malkani E, Martin S, Slack M, Trotter C, Jit M, George R & Miller E. Invasive pneumococcal disease (IPD) in England & Wales after 7-valent conjugate vaccine (PCV7); potential impact of 10 and 13-valent vaccines.
- Report of the Director of Immunisation: April 2009.(Accessed 17 Feb 2010).
- Pichon B, Beasley L, Slack M, Efstratiou A, Miller E. and George R. Effect of the introduction of the pneumococcal conjugate vaccine in the UK childhood immunisation scheme on the genetic structure of paediatric invasive pneumococci. (Accessed 17 Feb 2010)
- Department of Health. Immunisation against infectious diseases. Chapter 25: Pneumococcal. August 2006. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4137924.pdf (accessed 25 Feb 2010).
- Health Protection Agency. Clinical Management Protocol version 3: January 2007 (accessed 17 March 2008).
Pneumococcal vaccine in Ireland
There are currently two vaccines that protect against pneumococcal disease; a 23-type 'polysaccharide' vaccine for and a newer 7-type 'conjugate' vaccine.
23-type polysaccharide vaccine
This vaccine can protect most adults for five years or more against the top 23 disease causing types of pneumococcal infection. However, it does not work in children under two years old and is less effective in people with immune deficiencies and the under-fives.
7-type conjugate vaccine
The newer 7-type 'conjugate' vaccine is similar to the successful Hib and Men C vaccines, which provide stronger, more long-term protection than the plain polysaccharide vaccines, even in babies. This vaccine covers the seven types that cause over 80% of serious pneumococcal disease in Irish and UK children aged 6 months to 2 years and about 75% in the under fives in Europe generally. The routine use of this vaccine in America since June 2000 has established a good safety record and shown that it is effective. It is now also offered routinely in the UK, Australia, Canada, Austria, Italy, Spain and Norway.
This vaccine was introduced into the Irish childhood vaccination programme on 1 September 2008.
A newer 13-type vaccine will replace the 7-type later on this year.
Current schedule of vaccination in Ireland for children born on or after 1st July 2008
|2 months ||4 months ||6 months ||12 months ||13 months ||4-5 years |
|Diptheria/ Tetanus/ Pertussis/ Polio / Hib/ Hepatitis B |
|Diptheria/ Tetanus/ Pertussis/ Polio / Hib/ Hepatitis B |
|Diptheria/ Tetanus/ Pertussis/ Polio / Hib/ Hepatitis B |
|MenC ||MenC || |
|MenC || |
|Pneumococcal || |
|Pneumococcal ||Pneumococcal || |
|MMR || |
|Hib || |
|Diptheria/ Tetanus/ Pertussis/ Polio |
There is a catch-up programme if your child was born between 02/09/06-30/06/08. You can view this immunisation schedule at http://www.immunisation.ie/en/HotTopics/Text_15413_en.html
Please remember that although meningitis vaccines that are currently available can provide excellent protection, there are several major forms of meningitis and septicaemia for which there is no vaccine.
Travel & Hajj: ACWY quadrivalent vaccine
Meningococcal infection can cause meningitis, septicaemia or both. Five strains of meningococcal bacteria (A, B, C, W135 and Y) cause most cases. Although it occurs in all countries, it is much more common in certain areas. There are epidemics in the ‘meningitis belt’ of sub-Saharan Africa, usually due to meningococcal A or W135 bacteria, and from time to time there are outbreaks in other countries.
Large epidemics of meningococcal disease have been linked to the Hajj pilgrimage, at first due to A-strain and then in 2000/2001 to W135. Cases of meningococcal disease also occurred world-wide after pilgrims returned to their own countries.
Because of these epidemics, quadrivalent ACWY vaccination has been a compulsory entry requirement into Saudi Arabia for pilgrims on Hajj and Umrah, and for other travellers in Hajj season since 2002. It protects against meningitis and septicaemia caused by four different strains: A, C, W135 and Y. Vaccination is also recommended for travel to sub-Saharan Africa and certain other countries, especially if travellers will be living or working with local people or visiting during an outbreak. An up-to-date list of countries with potential risk can be obtained from www.nathnac.org.
Pilgrims on Hajj or Umrah are required to present a certificate of vaccination with ACWY, issued at least 10 days, but not more than 3 years before arrival. This also applies to seasonal workers in Hajj areas.
What vaccines are available?
There are three ACWY vaccines available. Menveo® and Nimenrix® are the most advanced vaccines, called ‘conjugate’ vaccines, ACWY Vax® is an older vaccine that does not work very well in young children. Although all vaccines are suitable for travel, the Department of Health recommends that children over 5 years of age and adults are vaccinated with a conjugate vaccine because they provide better and longer lasting protection. Children under 5 should always be vaccinated with conjugate vaccines. Those over 1 year of age should receive a single dose of either Nimenrix® or Menveo®. Babies under one year of age, should receive two doses of Menveo® one month apart for protection
The Muslim Council of Britain (MCB) have set up a national network of vaccination clinics in England, Scotland and Wales where Menveo® is offered to pilgrims travelling on Hajj or Umrah at a reduced price of no more than £35. This cost includes the cost of the vaccine, administration and the certificate. For more information, or to find your nearest clinic visit www.mcb-vac.co.uk
or call 08455 521 4160. The MCB network of vaccination clinics doesn’t cover Northern Ireland. GP practices and travel clinics can be contacted for information on vaccination.
Safety and acceptability
The ingredients of both the older polysaccharide vaccine and the newer conjugate vaccines have been in use for many years. Although mild side effects are fairly common, including pain where the vaccine was injected, and sometimes headache, or nausea, these reactions are similar to the reactions caused by routine vaccines.
Menveo® has been certified as Halal by the Indonesian Council of Ulama and the Islamic Services of America. Nimenrix® has been certified as Halal by the Halal Food Council of Europe.
- Lingappa, J.R., et al., Serogroup W-135 meningococcal disease during the Hajj, 2000. Emerg Infect Dis, 2003. 9(6): p. 665-71.
- Hahne, S.J., et al., W135 meningococcal disease in England and Wales associated with Hajj 2000 and 2001. Lancet, 2002. 359(9306): p. 582-3.
- 'Green Book'. Department of Health. Immunisation against infectious diseases. Chapter 22: Meningococcal. Updated April 2011. http://www.dh.gov.uk/en/Publichealth/Healthprotection/Immunisation/Greenbook/DH_4097254.
Measles, Mumps and Rubella
Before immunisation was available, measles, mumps and rubella were fairly common diseases that could have very serious complications:
The most common complications of measles infection are otitis media, pneumonia, blindness and encephalitis (inflammation of the brain) 1 .
Can cause complications ranging from inflammation of the pancreas and reproductive organs to deafness, meningitis (inflammation of the covering of the brain and spinal cord) and encephalitis.
Can cause birth defects such as deafness and heart defects in babies whose mothers contract the illness while pregnant.
The role of MMR vaccine in preventing meningitis
Before MMR vaccine was introduced, mumps was the main cause of viral (or aseptic) meningitis - about 1,200 people (mainly children) in the UK were hospitalised each year with mumps 2
. Most of these cases had meningitis. Mumps was also the most frequent cause of viral encephalitis.
Measles encephalitis occurs in approximately 1 in 1000 cases of measles infection 3 and can be fatal.
Since the introduction of MMR in 1988, mumps and measles meningitis and encephalitis have virtually been eliminated.
Following adverse publicity about MMR in 1998, uptake of the vaccine in England fell from over 90% to around 80%, causing widespread concern among health professionals about the risk of outbreaks of these diseases. Similar patterns were seen in Scotland 4 , Wales 5 , Northern Ireland 6 and the Ireland 7 .
Cases of Measles
As a result of the decline in MMR uptake, outbreaks of measles occurred in the Ireland in 2000 leading to at least two deaths 8 In England and Wales in 2006, at least one child has died following outbreaks of measles, the majority of which have been seen in Surrey, Sussex and South Yorkshire 9. Fortunately, parents' acceptance of MMR seems to be improving again and uptake rates look to be increasing 9 .
MMR* is given as two injections, one at 13 months (12 - 15 months in Ireland) and one between 3 - 5 years. Separate vaccines against measles, mumps and rubella would have to be given as six injections over a long period of time. Children would be left without protection in the gaps between injections and there would also be a fall in vaccine coverage as children may not complete the course of injections.
In particular, there is concern about the use of single vaccines and the impact on the occurrence of mumps and its complications. This is because, when seeking separate mumps immunisation, parents may find the vaccine they have obtained is the wrong sort. There are three strains of mumps vaccine available in Western Europe as single vaccines:
- Urabe, which does not have a license in the UK and was withdrawn from use here in 1992 as the vaccine itself was responsible for a higher than acceptable risk of aseptic meningitis 10
- Rubini which has been shown to be between only 1% and 22% effective 11
- Pavivac, which is not licensed in the UK because there are questions about its safety 12 .
The mumps component of the MMR vaccine is the Jeryl Lynn strain, which is safe and effective but not often possible to obtain as a single vaccine either in the UK or mainland Europe. Children's health could be jeopardised if inappropriate vaccine is given.
Safety of MMR vaccine
Although MMR vaccination has had much adverse publicity, there is no factual basis for this.
Although no medicine is 100% safe, vaccines undergo stricter testing than other medicines. Over 30 years, more than 500 million doses of MMR have been given in over 100 countries, and it has an excellent safety record.
Articles published in medical journals and in the national press claiming that MMR vaccination causes autism and bowel disease have been thoroughly investigated and the evidence from several studies has shown no link between these conditions and MMR or measles vaccines.
There is no evidence that supports getting measles, mumps and rubella vaccinations separately-MMR vaccination is safer and more effective.
In recent years, many myths surrounding vaccination have developed and speculative media stories have understandably raised parental anxiety. Vital signs, Vital issues contains a large section which attempts to dispel these myths. This booklet can be downloaded from our website .
* The MMR vaccines used in the UK are M-M-RTMII and Priorix.
- Perry RT and Halsey NA. The clinical significance of measles: a review. Journal of Infectious Disease. May 2004; 189. (accessed 28 June 2006)
- Department of Health. Immunisation against infectious diseases. 1996. http://www.dh.gov.uk/assetRoot/04/07/29/84/04072984.pdf (accessed 28 June 2006)
- NHS Health Scotland. Ready Steady Baby http://www.hebs.scot.nhs.uk/readysteadybaby/moreinfo/hebs_pub4.cfm?TxtTCode=1172 (accessed 28 June 2006)
- Scottish Health Statistics. Latest Primary Immunisation uptake rates. May 2006. http://www.isdscotland.org/isd/info3.jsp?p_applic=CCC&p_service=Content.show&pContentID=1652& (accessed 28 June 2006)
- Local Health Board. Neath Port Talbort. Board Meeting, 6th May 2004. http://www.wales.nhs.uk/sites3/documents/245/DirectorOfPublicHealth.PDF#search='uptake%20of%20mmr%20in%20wales (accessed 28 June 2006)
- CDSC NI. Communicable Diseases Monthly Report. March 2003. http://www.cdscni.org.uk/publications/MonthlyReports/Volume_12_2003/No_1.pdf#search='uptake%20of%20mmr%20northern%20ireland' (accessed 28 June 2006)
- NDSC. Immunisation Uptake Statistics for Ireland. May 2002. http://www.ndsc.ie/A-Z/VaccinePreventable/Vaccination/Publications/ImmunisationUptakeStatistics/2001/File,926,en.pdf#search='fall%20in%20mmr%20uptake' (accessed 28 June 2006)
- Parliament of Ireland. Report on Childhood Immunisation. 7 December 2000. http://www.irlgov.ie/Committees-01/c-health/rep-childhood/071200.htm (accessed 28 June 2006)
- Health Protection Agency. Measles cases so far in 2006. June 2006. http://www.hpa.org.uk/hpa/news/articles/press_releases/2006/060615_measles.htm (accessed 28 June 2006)
- Dourado I, Cunha S, Teixeira MG, Farrington CP, Melo A, Lucena R, Barreto ML. Outbreak of aseptic meningitis associated with mass vaccination with a urabe-containing measles-mumps-rubella vaccine: implications for immunization programs. Am J Epidemiol March 2000; 151(5):524-530 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10707922&query_hl=24&itool=pubmed_docsum (accessed 28 June 2006)11.
- Goncalves G, de Araujo A, Monteiro Cardoso ML. Outbreaks of mumps associated with poor vaccine efficacy - Oporto Portugal 1996. Eurosurveillance 1998; 3(12):119-121 http://www.eurosurveillance.org/em/v03n12/0312-222.asp (accessed 28 June 2006)
- NHS. Ban on import of Pavivac mumps vaccine extended. January 2003. http://www.mmrthefacts.nhs.uk/news/newsitem.php?id=38 (accessed 28 June 2006)