Green Book Immunisation: What It Is and How to Use It

The Green Book is the UK's guidance on vaccines and vaccination. Its full title is Immunisation against infectious disease, and the UK Health Security Agency (UKHSA) publishes it free on gov.uk. It covers how vaccines work, consent, storage, giving vaccines, adverse reactions and the immunisation schedule, plus a chapter for each vaccine-preventable disease. Chapters are updated one at a time as advice changes.

If your service gives vaccines, the Green Book sits alongside two other things you need: the legal authority to give each vaccine, and staff trained to UKHSA's national minimum standards. This guide covers all three, plus cold chain and anaphylaxis basics. It doesn't cover doses: those come from the chapter, the product information and your PGD or prescriber.

What the Green Book is

The RCN describes it as the home of immunisation policy for the UK, written and updated with public health agencies across the four nations. The Joint Committee on Vaccination and Immunisation (JCVI) advises the UK health departments, and the Green Book turns that advice into practical guidance for health professionals.

The online Green Book has two parts:

• Part 1: principles, practices and procedures. Twelve general chapters, including immunity and how vaccines work, consent, storage, immunisation procedures, contraindications, vaccine safety and adverse events, the UK immunisation schedule, and immunisation of healthcare staff.
• Part 2: the diseases, vaccinations and vaccines. A chapter for each disease, from anthrax to yellow fever, setting out the disease, the vaccines, who should have them, and contraindications.

How to use it in practice

The Green Book changes often, so always check the online chapter rather than a printed or saved copy. In 2026 alone, UKHSA has updated the chapters on the immunisation schedule, influenza, pneumococcal, RSV and COVID-19, among others. The childhood schedule itself changed from 1 January 2026, when the MMRV vaccine (measles, mumps, rubella and chickenpox) was introduced across the UK.

A few habits keep a vaccinating team current:

• Check the date on the chapter before each campaign or clinic, and read what changed.
• Read the chapter with your PGD or protocol. They should agree. If they don't, stop and ask your clinical lead.
• Brief the team when a chapter changes, and record that you did.
• Bookmark Part 1. Consent, storage and adverse events apply to every vaccine you give.

PGDs and PSDs: the legal authority to vaccinate

Vaccines are prescription-only medicines, so someone needs legal authority to give each one. The Green Book's chapter 5 explains the two main routes besides a prescription:

• Patient Specific Direction (PSD): a written instruction from a prescriber to give a medicine to a named patient or patients. The prescriber has assessed each person.
• Patient Group Direction (PGD): written instructions for the supply or administration of a medicine to groups of patients who may not be identified before they present. Each health professional working under a PGD must be named on it and sign it, and the employer must make sure they're trained to use it.

Healthcare support workers can give some vaccines, but UKHSA's training standards are clear that working to PGDs and carrying out the clinical assessment for vaccination are outside their scope of practice. They work within delegation from a registered professional, usually under a PSD, and the standards consider injected vaccines for babies and pre-school children unsuitable for support workers. In England, the flu and COVID-19 programmes have also used national protocols, which set out who can give the vaccine and the training they need.

The detail depends on your setting and the nation you work in, so follow your local policy and the documents that authorise each vaccine.

UKHSA national minimum standards for immunisation training

UKHSA's National Minimum Standards and Core Curriculum for Vaccination Training sets out what good immunisation training looks like. The 2025 version merged the separate standards for registered professionals and healthcare support workers into one document. The standards are best practice rather than law, but they expect employers to make sure everyone who gives or advises on vaccines is trained to them, and commissioners to check. Key points:

• Foundation training before starting. New vaccinators need full foundation training, face to face or blended with e-learning. For staff giving a range of vaccines, the theory would need at least two days, which may include e-learning. E-learning alone is not enough.
• Assessment before vaccinating alone. Knowledge and clinical skills should be assessed and recorded before new vaccinators start, with supervised practice until both the vaccinator and their supervisor are confident.
• An annual update for everyone who vaccinates, in person or virtually, likely to need at least half a day.
• Anaphylaxis and basic life support annually, or as your employer requires, usually separate from the vaccination training itself.

Cold chain basics

Vaccines are sensitive biological products. Chapter 3 of the Green Book covers storage. In short:

• Store vaccines as the manufacturer specifies, usually between +2°C and +8°C, and protected from light.
• Use a specialised pharmaceutical fridge, never a domestic one, and never store food, drink or specimens with vaccines.
• Check and record the fridge temperature at least once each working day with a maximum-minimum thermometer: read, record, reset, react.
• Name at least two people responsible for ordering, receiving and storing vaccines.

If the temperature goes out of range, don't simply bin the stock. Keep the fridge closed, quarantine and label the affected vaccines, report it through your incident process and get expert advice. Some vaccines may still be usable after a risk assessment; some people may need vaccinating again.

Anaphylaxis: be ready before the first dose

Anaphylaxis after vaccination is rare. Chapter 8 of the Green Book puts it at less than 1 per million doses for vaccines in the UK. But it comes on quickly, usually within minutes, so readiness matters more than odds.

• An anaphylaxis pack should be immediately available wherever vaccines are given, not locked away, and checked regularly for expiry.
• Intramuscular adrenaline is the first-line treatment. Call 999 and say "anaphylaxis".
• Follow the Resuscitation Council UK algorithm, which the chapter reproduces.
• Know the difference between a faint and anaphylaxis. A faint usually comes with a slow pulse and improves when the person lies flat.
• Report suspected reactions through the MHRA Yellow Card scheme.

The chapter says staff who give vaccines should have annual updates in anaphylaxis management. Our anaphylaxis training and Basic Life Support training can sit alongside your vaccination training. For which resuscitation level fits which role, see the difference between ILS, BLS and EFAW.

How Kasorb can help

Kasorb's immunisation, vaccination and anaphylaxis training prepares nurses and healthcare staff to give vaccines safely, with content aligned to UKHSA's national minimum standards and core curriculum. There's a foundation course for new vaccinators and an annual update for everyone who vaccinates.

The session covers how vaccines work, vaccine-preventable diseases and the national schedule, PGDs and PSDs, storage and the cold chain, consent, injection technique, recognising and managing anaphylaxis, and documenting and reporting adverse events. Staff practise injection technique and an anaphylaxis scenario under observation. It runs on-site anywhere in the UK for up to 10 staff, at one price for the group, quoted for your team. Your trainer has used these skills for real. Certificates are emailed the next day, and your own supervised sign-off follows, as with any clinical skill.

This guide summarises the law and guidance; it isn't legal advice.

FAQs

What is the Green Book in immunisation?

The Green Book is Immunisation against infectious disease, the UK's guidance on vaccines and vaccination, published online by the UK Health Security Agency. Part 1 covers principles such as consent, storage and adverse events. Part 2 has a chapter for each vaccine-preventable disease. Chapters are updated individually, so always use the online version.

How often do vaccinators need immunisation training?

UKHSA's national minimum standards expect new vaccinators to complete foundation training and a recorded assessment before they start, then everyone who vaccinates to have an annual update. Anaphylaxis and basic life support training should also be updated annually, or as your employer requires.

Can healthcare support workers give vaccines under a PGD?

No. UKHSA's training standards say working to Patient Group Directions is outside a healthcare support worker's scope of practice, as is the clinical assessment for vaccination. Support workers give vaccines within delegation from a registered professional, usually under a Patient Specific Direction, after the right training.

Is e-learning enough for immunisation training?

Not on its own. UKHSA's standards say foundation training should be face to face or blended, and that e-learning alone should not be considered sufficient. New vaccinators also need their clinical skills assessed and recorded, with supervised practice, before they give vaccines unsupervised.

What temperature should vaccines be stored at?

Follow the manufacturer's instructions, which usually means between +2°C and +8°C, protected from light, in a specialised pharmaceutical fridge. The Green Book says fridge temperatures must be checked and recorded at least once each working day using a maximum-minimum thermometer.