Please see section 14.2 Immunoglobulins for immunoglobulin therapies

Cholera vaccine

Please refer to Cholera (The Green Book; Chapter 14) for further information, including dosing and treatment regimens

Dukoral

• Vibrio cholerae, recombinant cholera toxin b subunit (inactivated) vaccine
• Oral suspension

Vaxchora

• Vibrio cholerae, recombinant, (live) vaccine
• Effervescent powder and powder for oral suspension

Please see International travel for advice on immunisation for travel abroad

Coronavirus (COVID-19) vaccine

For the latest updates and advice on COVID-19, please visit the NHS website.

For formulary guidance on COVID-19 treatments for patients who do not require hospitalisation, please click here.

For Clinical Referral Guideline (CRG) updates specific to the COVID-19 pandemic, please click here.

The use of these vaccines should be in accordance with national recommendations. 

For autumn 2024, the Joint Committee on Vaccination and Immunisation (JCVI) advises that a COVID-19 vaccine should be offered to:

• adults aged 65 years and over
• residents in a care home for older adults
• persons aged 6 months to 64 years in a clinical risk group (as defined in tables 3 and 4 of The Green Book; Chapter 14a).

Documents relating to the COVID-19 vaccination programme, including; protocols and patient group directives (PGDs), can be found here.

Please refer to COVID-19 (The Green Book; Chapter 14a) for further information, including dosing and treatment regimens.

COVID-19 mRNA Vaccines

For all individuals aged 18 years and over:

Comirnaty JN.1 (Pfizer-BioNTech COVID-19 vaccine)

• COVID-19 mRNA vaccine (nucleoside modified)
• 30micrograms/0.3ml dose dispersion for injection pre-filled syringes
• 30micrograms/0.3ml dose dispersion for injection multidose vials

Notes

1. Comirnaty JN.1 30micrograms/0.3ml dose is also suitable for young people aged 12 to 17 years.

Spikevax JN.1 (Moderna COVID-19 vaccine)

• COVID-19 mRNA vaccine (nucleoside modified)
• 50micrograms/0.5ml dose dispersion for injection pre-filled syringes
• 0.1mg/ml dispersion for injection multidose vials

For children aged 5 to 11 years:

Comirnaty JN.1 (Pfizer-BioNTech COVID-19 vaccine)

• COVID-19 mRNA vaccine (nucleoside modified)
• 10micrograms/0.3ml dose dispersion for injection single dose vials

For children aged 6 months to 4 years:

Comirnaty JN.1 (Pfizer-BioNTech COVID-19 vaccine)

• COVID-19 mRNA vaccine (nucleoside modified)
• 3micrograms/0.3ml dose concentrate for dispersion for injection multidose vials

Protein Subunit Vaccines COVID-19 Vaccines

Bimervax (HIPRA Human Health COVID-19 vaccine)

• COVID-19 vaccine (recombinant, adjuvanted)
• 40micrograms/0.5ml dose emulsion for injection multidose vials

Notes

1. Bimervax may be used as a booster dose for persons aged 16 years and above when alternative products are considered not clinically suitable.

Nuvaxovid XBB.1.5 (Novavax COVID-19 vaccine)

• COVID-19 vaccine (recombinant, adjuvanted)
• 5micrograms/0.5ml dose dispersion for injection multidose vials

Notes

1. Nuvaxovid may be used as a booster dose for persons aged 12 years and above when alternative products are considered not clinically suitable.

Additional COVID-19 vaccine information

MHRA information and guidance for industry, healthcare professional, and patients on coronavirus (COVID-19) can be found here.

Information and guidance from across SPS on pharmaceutical aspects of COVID-19 vaccines’ use including Standard Operational Procedures (SOPs) for managing COVID-19 vaccines, and safety in pregnancy and breastfeeding, see here.

To check for an interaction between a COVID-19 vaccine and individual drugs, see the following site: University of Liverpool COVID-19 Drug Interactions.

Reporting side effects

Healthcare professionals are asked to report any suspected side effects to COVID-19 vaccines. Report using the dedicated Coronavirus Yellow Card reporting site or the Yellow Card app.

Diphtheria vaccine

Diphtheria and tetanus vaccines are only given as part of combined products

Please refer to Diphtheria (The Green Book; Chapter 15) for further information, including dosing and treatment regimens

Please refer to Tetanus (The Green Book; Chapter 30) for further information, including dosing and treatment regimens

Please refer to Pertussis (The Green Book; Chapter 24) for further information, including dosing and treatment regimens

Please refer to Polio (The Green Book; Chapter 26) for further information, including dosing and treatment regimens

Infanrix-IPV+Hib

• Diphtheria, tetanus, pertussis (acellular component), poliomyelitis (inactivated), and Haemophilus influenzae type b conjugate vaccine (adsorbed) (DTaP/IPV/Hib)
• Powder and suspension for suspension for injection

Pediacel

• Diphtheria, tetanus, pertussis (acellular, component), poliomyelitis (inactivated) and Haemophilus type b conjugate vaccine (adsorbed) (DTaP/IPV/Hib)
• Suspension for injection in pre-filled syringe

Repevax

• Diphtheria, tetanus, pertussis (acellular, component) and poliomyelitis (inactivated) vaccine (adsorbed, reduced antigen(s) content) (DTaP/IPV)
• Suspension for injection in pre-filled syringe

Infanrix IPV

• Diphtheria, tetanus, pertussis (acellular, component) and poliomyelitis (inactivated) vaccine (adsorbed) (DTaP/IPV)
• Suspension for injection in pre-filled syringe

Revaxis

• Diphtheria, tetanus and poliomyelitis (inactivated) vaccine (adsorbed, reduced antigen(s) content) (Td/IPV)
• Suspension for injection in pre-filled syringe

Infanrix Hexa

• Diphtheria, tetanus, pertussis (acellular component), hepatitis B (rDNA), poliomyelitis (inactivated), and Haemophilus influenzae type b conjugate vaccine (adsorbed) (DTaP/IPV/Hib/HepB)
• Powder and suspension for suspension for injection

Vaxelis

• Diphtheria, tetanus, pertussis (acellular, component), hepatitis B (rDNA), poliomyelitis (inactivated), and Haemophilus type b conjugate vaccine (adsorbed)
• Suspension for injection in pre-filled syringe

Boostrix-IPV

• Diphtheria, tetanus, pertussis (acellular, component) and poliomyelitis (inactivated) vaccine (adsorbed, reduced antigen(s) content) (DTaP/IPV)
• Suspension for injection in pre-filled syringe

ADACEL

• Diphtheria, tetanus, pertussis (acellular component) vaccine (adsorbed, reduced antigen(s) content) (TdaP)
• Suspension for injection in pre-filled syringe

Please see International travel for advice on immunisation for travel abroad

Haemophilus type B (Hib) vaccine

Hib vaccines are available as part of combined products DTaP/IPV/Hib or Hib/MenC

Please refer to Haemophilus influenzae type b (Hib) (The Green Book; Chapter 16) for further information, including dosing and treatment regimens

The Joint Committee on Vaccination and Immunisation (JCVI) has been notified of the discontinuation of Menitorix (Hib/MenC). This necessitates a change to the routine schedule as this vaccine is currently given at 12 months. Please refer to the Joint Committee on Vaccination and Immunisation (JCVI) interim statement on the immunisation schedule for children (05 August 2022).

Please see International travel for advice on immunisation for travel abroad

Hepatitis A vaccine

Hepatitis A vaccines are available as either monovalent, or combined with hepatitis B

Please refer to Hepatitis A (The Green Book; Chapter 17) for further information, including dosing and treatment regimens

Monovalent vaccines

Avaxim

• Hepatitis A vaccine (inactivated, adsorbed) (HepA)
• Suspension for injection in pre-filled syringe

Avaxim Junior

• Hepatitis A vaccine (inactivated, adsorbed) (HepA)
• Suspension for injection in pre-filled syringe

Havrix Monodose

• Hepatitis A (inactivated) vaccine (adsorbed) (HepA)
• Suspension for injection in pre-filled syringe

Havrix Junior Monodose

• Hepatitis A (inactivated) vaccine (adsorbed) (HepA)
• Suspension for injection in a pre-filled syringe

VAQTA Adult

• Hepatitis A (inactivated) vaccine (adsorbed) (HepA)
• Suspension for injection

VAQTA Paediatric

• Hepatitis A (inactivated) vaccine (adsorbed) (HepA)
• Suspension for injection

Please see International travel for advice on immunisation for travel abroad

Combined Hepatitis A and B vaccine

Guidance for hepatitis A and B vaccination in drug users in primary care

• It has been recommended that all people who inject drugs are vaccinated against hepatitis A and B
• While a combined A and B vaccine is available to assist this, the standard schedule for delivering it is longer than if providing hepatitis B vaccine alone

For information on combination Hepatitis A and B vaccines in drugs users in primary care, please refer to Drug misuse and dependence: UK guidelines on clinical management (Department of Health and Social Care) (Also called 'The Orange Book')

Hepatitis B vaccine

Hepatitis B vaccines can be given as a single or combined product (Infanrix Hexa)

Please refer to Hepatitis B (The Green Book; Chapter 18) for further information, including dosing and treatment regimens

Hepatitis B vaccine and Chronic Kidney Disease (CKD)

Immunisation against hepatitis B is recommended for patients already on dialysis or renal transplantation programmes and for other patients with chronic renal failure as soon as it is anticipated that they may require these interventions.

People who will need dialysis or may have a kidney transplant in the future are all offered immunisation.

The commissioning and provision of Hepatitis B Vaccination for patients with Chronic Kidney Disease (CKD) is the responsibility of renal services in secondary care.

Nephrology outpatient activity remains the commissioning responsibility of ICBs.

The vaccines formulated for use in patients with chronic renal insufficiency should be used, see drug entries below.

Please refer to Chronic Kidney Disease CRG for information on detection and classification of CKD

• Western Locality

Specific information regarding the safety of adults with chronic kidney disease and what you need to stop or start (NICE COVID-19 rapid guideline NG176) during the Coronavirus (COVID-19) pandemic can be found here.

Engerix B

• Hepatitis B (rDNA) vaccine (adsorbed) (HepB)
• Suspension for injection in pre-filled syringe
• In renal insufficiency, including dialysis patients aged over 1 month (hospital only)
  

HBvaxPRO 5mcg (Paediatric)

• Hepatitis B vaccine (rDNA) (HepB)
• Suspension for injection in pre-filled syringe

HBvaxPRO

• Hepatitis B vaccine (rDNA) (HepB)
• Suspension for injection

PreHevbri

• Hepatitis B vaccine (recombinant, adsorbed) (HepB)
• Suspension for injection

HBvaxPRO40

• Hepatitis B vaccine (rDNA) (HepB)
• Suspension for injection in pre-filled syringe
• Indicated for immunisation in chronic dialysis patients aged 16 years or older (hospital only)

Fendrix

• Hepatitis B (rDNA) vaccine (adjuvanted, adsorbed) (HepB)
• Suspension for injection
• Indicated for immunisation in renal insufficiency including patients aged 15 years or older (hospital only)

Please see International travel for advice on immunisation for travel abroad

Human papilloma virus (HPV) vaccine

See Public Health England Cervical screening: professional guidance

Please refer to Human papillomavirus (HPV) (The Green Book; Chapter 18a) for further information, including dosing and treatment regimens

Gardasil 9

• Human Papillomavirus 9-valent vaccine [Types 6, 11, 16, 18, 31, 33, 45, 52, 58] (Recombinant, adsorbed) (HPV)
• Suspension for injection
• Suspension for injection in pre-filled syringe

Influenza vaccine

The national annual flu immunisation programme, can be found here (DHSC, PHE, and NHSE)

National flu immunisation programme plan (DHSC, PHE, and NHSE)

Please refer to Influenza (The Green Book; Chapter 19) for further information, including dosing and treatment regimens

Inactivated influenza vaccine

• Suspension for injection in pre-filled syringe

Recombinant influenza vaccine

• Solution for injection in pre-filled syringe

Live attenuated influenza vaccine

• Nasal spray suspension

Please see Upper respiratory tract infections for Influenza (flu) guidance

Annual guidance may change; check the GOV.UK website (seasonal influenza) for latest updates.

Measles, Mumps, and Rubella (MMR) vaccine

Please refer to Measles (The Green Book; Chapter 21) for further information, including dosing and treatment regimens

Please refer to Mumps (The Green Book; Chapter 23) for further information, including dosing and treatment regimens

Please refer to Rubella (The Green Book; Chapter 28) for further information, including dosing and treatment regimens

Pregnancy should be avoided for one month following MMR vaccination.

MMRVaxPRO

• Measles, mumps, and rubella vaccine (Live) (MMR)
• Powder and solvent for suspension for injection in pre-filled syringe

Priorix

• Measles, mumps, and rubella vaccine (Live) (MMR)
• Powder and solvent for suspension for injection in pre-filled syringe

Meningococcal vaccines

Please refer to Meningococcal (The Green Book; Chapter 22) for further information, including dosing and treatment regimens

Meningococcal Group B vaccine

Bexsero

• Meningococcal group B vaccine (rDNA, component, adsorbed) (MenB)
• Suspension for injection in pre-filled syringe

Trumenba

• Meningococcal group B vaccine (recombinant, adsorbed) (MenB)
• Suspension for injection in pre-filled syringe

Meningococcal Group C conjugate vaccine

A conjugate of Haemophilus type B and Meningococcal group C is available, see section on Haemophilus type B (above).

NeisVac-C

• Meningococcal group C polysaccharide conjugate vaccine (adsorbed) (MenC)

Meningococcal groups A, C, W-135, and Y conjugate vaccine

Nimenrix

• Meningococcal group A, C, W135 and Y conjugate vaccine (MenACWY)
• Powder and solvent for solution for injection in pre-filled syringe

Menveo

• Meningococcal group A, C, W135 and Y conjugate vaccine (MenACWY)
• Powder and solution for solution for injection

MenQuadfi

• Meningococcal group A, C, W135 and Y conjugate vaccine (MenACWY)
• Solution for injection

Pneumococcal vaccines

Please refer to Pneumococcal (The Green Book; Chapter 25) for further information, including dosing and treatment regimens

Prevenar 13

• Pneumococcal polysaccharide conjugate vaccine (13-valent, adsorbed) (PPV)
• Suspension for injection

Pneumovax 23

• Pneumococcal polysaccharide vaccine (23-valent) (PPV)
• Solution for injection in pre-filled syringe

Respiratory syncytial virus (RSV)

Please refer to Respiratory syncytial virus (The Green Book; Chapter 27a) for further information, including dosing and treatment regimens

Abrysvo

• Respiratory syncytial virus vaccine (bivalent, recombinant) (RSV)
• Powder and solvent for solution for injection

Arexvy

• Respiratory syncytial virus vaccine (recombinant, adjuvanted) (RSV)
• Powder and suspension for suspension for injection

Monoclonal antibodies for passive immunisation for RSV listed elsewhere in the formulary:

• Nirsevimab (Beyfortus) and Palivizumab (Synagis), see section 5.3.5 Respiratory syncytial virus (RSV)

Rotavirus vaccine

Please refer to Rotavirus (The Green Book; Chapter 27b) for further information, including dosing and treatment regimens

Rotarix

• Rotavirus vaccine (Live)
• Suspension in pre-filled oral applicator

Tuberculosis vaccines

Please refer to Tuberculosis (The Green Book; Chapter 32) for further information, including dosing and treatment regimens

BCG (Bacillus Calmette-Guérin) Vaccine AJV

• Mycobacterium bovis vaccine (Live)
• Powder and solvent for suspension for injection

Please see International travel for advice on immunisation for travel abroad

Diagnostic agents

Tuberculin Purified Protein Derivative (PPD) AJV (Mantoux)

• 2TU/0.1ml tuberculin PPD syringe

Typhoid vaccines

Typhoid vaccines are available as either monovalent, or combined with hepatitis A

Please refer to Typhoid (The Green Book; Chapter 33) for further information, including dosing and treatment regimens

Typhim Vi

• Typhoid Polysaccharide Vaccine
• Solution of injection

Vivotif

• Typhoid Polysaccharide Vaccine
• Oral capsule

Please see International travel for advice on immunisation for travel abroad

Varicella-zoster vaccine

The Department of Health recommends varicella-zoster vaccine for seronegative healthcare workers who come into direct contact with patients. Those with a history of chickenpox or shingles can be considered immune, but healthcare workers with a negative or uncertain history should be tested.

After vaccination, contact with the following should be avoided if a vaccine-related cutaneous rash develops within 4-6 weeks of the first or second dose:

• Varicella-susceptible pregnant women
• Individuals at high risk of severe varicella, including those with immunodeficiency or those receiving immunosuppressive therapy

Healthcare workers who develop a generalised papular or vesicular rash on vaccination should avoid contact with patients until the lesions have crusted.

Please refer to Varicella (The Green Book; Chapter 34) for further information, including dosing and treatment regimens

Prevention of varicella zoster infection (chickenpox)

Varivax

• Varicella-zoster virus (Live), propagated in MRC5 human diploid cells
• Powder and solvent for suspension for injection,

Varilrix

• Varicella-zoster virus (Live), propagated in MRC5 human diploid cells
• Powder and solvent for suspension for injection

Prevention of herpes zoster (shingles)

Please refer to Shingles (herpes zoster) (The Green Book; Chapter 28a) for further information, including dosing and treatment regimens

The eligible age for immunocompetent individuals will change from 70 to 60 years of age for the routine cohort, in a phased implementation over a 10 year period.

The routine offer will move from 70 to 60 years of age in 2 stages over a 10 year period as follows:

During stage 1 (1 September 2023 to 31 August 2028)

Shingrix will be offered to those turning 70 and 65 years on or after 1 September 2023.

Zostavax will be offered to persons aged between 70 to 79 that were eligible for the vaccination programme before 1 September 2023. Once all stocks of Zostavax are exhausted, these individuals can be offered Shingrix if they have not previously been given a shingles vaccine.

During stage 2 (1 September 2028 to 31 August 2033)

Shingrix will be offered to those turning 65 and 60 years of age.

From 1 September 2033 and thereafter, Shingrix will be offered routinely at age 60 years.

Those who have been previously eligible (in stages 1 and 2) will remain eligible until their 80th birthday.

For more information on the shingles vaccination programme, see here.

Shingrix

• Shingles (herpes zoster) vaccine (recombinant, adjuvanted)
• Powder and suspension for suspension for injection

Notes

1. Shingrix should be offered to all immunocompromised people for whom Zostavax is contraindicated, but who are eligible for vaccination under the current programme

Vaccines for travel that cannot be given as an NHS service

The following vaccines cannot be provided as an NHS service when required for travel immunisation

Japanese B Encephalitis

Please refer to Japanese encephalitis (The Green Book; Chapter 20) for further information, including dosing and treatment regimens

Please see International travel for advice on immunisation for travel abroad

Rabies vaccine

Please refer to Rabies (The Green Book; Chapter 27) for further information, including dosing and treatment regimens

Please see International travel for advice on immunisation for travel abroad

Tick-borne encephalitis vaccine

Please refer to Tick-borne encephalitis (The Green Book; Chapter 31) for further information, including dosing and treatment regimens

Please see International travel for advice on immunisation for travel abroad

Yellow fever vaccine

Please refer to Yellow fever (The Green Book; Chapter 35) for further information, including dosing and treatment regimens

Please see International travel for advice on immunisation for travel abroad

• Yellow fever vaccines can only be given by designated Yellow Fever Vaccination Centres, details of which can be found on the NaTHNac website: www.nathnac.org.
• MHRA Drug Safety Update (April 2019): Yellow fever vaccine (Stamaril) and fatal adverse reactions: extreme caution needed in people who may be immunosuppressed and those 60 years and older
• MHRA Drug Safety Update (November 2019): stronger precautions in people with weakened immunity and in those aged 60 years or older
• MHRA Drug Safety Update (November 2021): Yellow fever vaccine (Stamaril): new pre-vaccination checklist