US and UK vaccination differences: a guide for families moving to the UK

The two countries protect against most of the same infections on different timetables, and several vaccines that are standard in the United States are not offered routinely here at all. Here is what changes, and what to do about it.

We have been looking after American and Canadian families in London since Coyne Medical opened in 2016, many of them here on corporate relocations or on embassy and diplomatic postings, and vaccination is the thing that most often gets missed. Nobody raises it when you register with a GP, no school will ask for a record, and the gaps only become apparent when a child is due something and does not get it.

This guide covers the differences that matter, for children and for adults. It sits alongside our wider guide to family health for people moving to the UK from the United States.

One thing to settle early is which schedule you want to follow. If your move is for a few years and you expect to return to the United States, it is worth keeping your children up to date with the American schedule as well as the UK one, so that they arrive back fully covered rather than needing to catch up on vaccines that were never offered here. Vaccines that are routine in the United States but not in the UK, such as hepatitis A, can be arranged privately at any point.

How to transfer your US immunisation records to a UK GP

Download your family’s immunisation records from your US patient portal before you go, or ask your paediatrician’s office for a printed copy. Most American states also hold records on a state immunisation information system, so you can request them even if you have changed doctors.

Bring the actual dates and vaccine names, not a summary. UK practices cannot see American records, and where a record is missing, unclear, or lists a vaccine that is unfamiliar here, repeating a dose is sometimes recommended. That is usually safe, but it may not have been necessary, and it is easily avoided by arriving with the detail.

When you register with an NHS GP, hand the record in and ask for it to be added to your child’s notes. Children born here are given a personal child health record, usually called the red book. If your child arrives partway through the schedule, ask the practice nurse to map what they have already had against the UK schedule so you can see what is outstanding. The two schedules are published in full and are worth comparing side by side:

• NHS vaccination schedule
• CDC immunization schedules

How the UK and US schedules differ

Both countries protect against most of the same infections, and the childhood course is broadly similar in its first year. The differences are concentrated in the timing of the second measles dose, in the teenage vaccines, and in a handful of vaccines that one country gives routinely and the other does not. The table below covers the differences rather than the full schedule.

Why the second MMR dose is given earlier in the UK

This is the most important difference for young children. In the United States the second dose of MMR is usually given between four and six years of age, before starting school. In the UK it is now given at 18 months, having previously been at three years and four months.

The reason matters. Measles is one of the most infectious diseases known, cases have been rising across the UK, Europe and the United States, and young children have the highest risk of serious complications including pneumonia and inflammation of the brain. Bringing the second dose forward closes a window when children are both vulnerable and starting to mix in nursery settings.

If your child had their first MMR in the United States and is now over 18 months, they may be due their second dose sooner than you expect. Check rather than waiting for an invitation.

Chickenpox (varicella) is now part of the UK schedule

Since January 2026, MMR and chickenpox are given together in the UK as a single MMRV vaccine, at 12 months and 18 months. Chickenpox vaccination had not previously been part of the routine UK schedule at all.

Chickenpox vaccination has been routine in the United States for many years, so most American children will already be protected. Bring those dates with you, because a child who has had two varicella doses in the United States does not need the chickenpox component again. There is also a catch-up programme running for older children in the UK who have neither had chickenpox nor been vaccinated against it, so it is worth asking where your child sits.

Hepatitis B: there is no birth dose in the UK

American babies are given a dose of hepatitis B vaccine at birth, usually before leaving hospital. British babies are not. Hepatitis B is included in the six in one vaccine given at eight, twelve and sixteen weeks, so protection arrives by a different route and a little later.

The exception is a baby whose mother carries hepatitis B, who is vaccinated at birth here as well and followed up afterwards. If you are expecting a baby in the UK and are used to the American approach, it is worth knowing this in advance rather than asking for it in the delivery room. A birth dose can be arranged privately if you would prefer to follow the American schedule.

Why hepatitis A is not routine in the UK

In the United States, hepatitis A vaccination is given to all children from 12 months. In the UK it is offered only to specific risk groups and to travellers, so most British children and adults have never had it.

Hepatitis A spreads easily through contaminated food and water and through close personal contact. It causes liver inflammation that can last for months, and it is more severe in adults than in children. It is also very effectively prevented by two doses that give long lasting protection.

If your family was vaccinated in the United States, you are covered and there is nothing to do. If you have children born here, or you are planning travel outside northern Europe, it is worth considering privately.

BCG and tuberculosis

BCG protects against tuberculosis and is not used in the United States at all, so most American parents will never have encountered it. In the UK it is offered to babies at higher risk, usually those living in an area where tuberculosis is more common or whose parents or grandparents were born in a country with a high incidence. It is not offered to every baby, and if yours is offered it, this is the reason.

We give BCG to babies and children at the clinic. That covers children who would have qualified on the NHS but were never offered it, families moving on to or spending extended time in a country where tuberculosis is common, and parents who simply want their child protected. Children under six can be vaccinated straight away. Above that age a tuberculosis screening test is needed first, to check the child has not already been exposed, which means a second visit. It is worth asking before your child turns six if it is something you are considering.

HPV vaccination: one dose here, two or three in the US

Both countries vaccinate against HPV, which prevents cervical cancer and several other cancers in both sexes, but the number of doses differs. The UK now gives a single dose, offered in school at 12 to 13 to all children. American guidance is two doses starting at 11 to 12, or three if the course begins at 15 or older.

A child who has already had a dose in the United States will usually be counted as covered under the UK schedule, though it is worth confirming with your GP rather than assuming. If you expect to return to the United States, completing the American course is the safer course, since a single dose may not be accepted there. Consent for the school dose is requested by the school, so watch for it in the same way as for the other teenage vaccines.

Do UK teenagers need the MenB vaccine?

The UK gives MenB to babies but not routinely to teenagers. American guidance takes the opposite view for older teenagers, recommending a discussion about MenB vaccination for young people aged 16 to 23, particularly those heading to college.

The logic behind the American position applies just as well here. Meningococcal B disease is rare but moves fast and can be fatal within hours, and rates peak in late teens and young adults living in halls of residence or shared student housing. Older teenagers who were vaccinated as infants in the UK, and those who missed MenB entirely because they were born in the United States, are both worth reviewing before university.

MenB is available privately. If you have a teenager approaching sixth form or university, this is a conversation to have well before they move out rather than in the week they leave.

Does the UK give Tdap to teenagers?

Not in the form you would recognise. The UK teenage booster is Td/IPV, given at around 13 to 14 in school, and it covers tetanus, diphtheria and polio. It does not contain the whooping cough component, so it is not the equivalent of the American Tdap given at 11 to 12.

In practice this means whooping cough protection in the UK comes from the infant course and from vaccination in pregnancy, and is not topped up in adolescence as it is in the United States. If your teenager needs a documented Tdap for a US school, a summer camp or a move back home, it can be arranged privately.

Flu vaccination for adults: who the NHS covers

American adults are used to being offered a flu vaccine every autumn regardless of age or health. The NHS approach is narrower, and healthy adults under 65 are not included.

Free NHS vaccination goes to those at greatest risk. That broadly means adults aged 65 and over, pregnant women, people with certain long term conditions, carers, people who live with someone who is immunosuppressed, and frontline health and social care staff. Children are covered by a separate programme. Two and three year olds are offered vaccination at their GP practice, and school aged children are usually offered it at school as a nasal spray rather than an injection, which most children much prefer. Consent is requested by the school, so watch for the request in the same way as for the teenage vaccinations.

Many adults outside those groups choose to pay for a flu vaccine anyway, either at a pharmacy or a private GP clinic, and the reasoning is usually as much about the household as the individual. Adults who are not vaccinated are a common route by which flu reaches a baby too young to be vaccinated, or an elderly grandparent. Vaccination from early October gives good cover through the season.

Can you get the shingles vaccine at 50 in the UK?

The United States recommends shingles vaccination from age 50. The NHS offers it at 65 and 70, with a catch up for people aged 70 to 79, and from 50 for those who are severely immunosuppressed.

Shingles becomes more common and more severe with age, and the nerve pain that can follow it is debilitating and difficult to treat. There is also a growing body of evidence from large population studies suggesting that shingles vaccination is associated with a lower risk of developing dementia. That evidence is observational and has not changed NHS policy, so it is best treated as a possible additional benefit rather than the main reason to vaccinate. It is, however, reasonable to weigh if you are in your fifties and deciding whether to pay privately rather than wait until 65.

Whooping cough: protecting a newborn

Both countries vaccinate pregnant women against whooping cough, which passes antibodies to the baby before birth and is the single most effective thing that can be done. The UK offers it from 16 weeks of pregnancy.

Where the two diverge is what happens around the baby. American guidance encourages cocooning, meaning that fathers, grandparents, older siblings and anyone else in regular close contact are brought up to date with a whooping cough booster, given as Tdap. The NHS does not offer this, and as set out above the UK teenage booster does not contain the whooping cough component either.

Whooping cough is at its most dangerous in the first weeks of life, before a baby has had any vaccines of their own, and the infection is usually brought into the household by an adult whose childhood immunity has long since faded. Families used to the American approach often want to continue it here, and boosters can be arranged privately for anyone who will be around the baby.

Do UK schools require vaccination records?

No. UK schools do not require proof of vaccination for entry, unlike most American states, so nobody will ask you for a record. Your GP practice may send a reminder if a child appears to be behind, but nothing follows it up in the way an American school or paediatric practice would. Because there are also no routine well child visits after the first couple of years, there is no appointment at which somebody would notice, and it is easy to get behind without realising.

Teenage vaccinations are delivered in school by a separate immunisation service rather than by your GP, so consent forms arrive home in a school bag. If a form is missed, the vaccine is missed, and it will not be picked up automatically at a GP appointment.

Which US vaccines are not available on the NHS?

Several vaccines that are routine in the United States are not offered on the NHS, either at all or for your age group. The list in practice is hepatitis A, MenB for teenagers, Tdap boosters for adults and adolescents, flu for healthy adults under 65, and shingles before 65. A hepatitis B birth dose is not given either, other than to babies whose mothers carry the virus, and BCG is limited to babies who meet the risk criteria. All of these can be arranged privately.

So the sequence when you arrive is simple. Register with an NHS GP, hand over your records, and ask for a review of where each family member sits against the UK schedule. Then decide separately about the vaccines above, because those will never come up on their own.

At Coyne Medical we see a lot of families in exactly this position. A review of your records against both schedules will usually make clear what is outstanding, what has already been covered, and what is worth adding.