Routine varicella (chickenpox) vaccination for young children from 1 January 2026 (WHC/2025/046)

Status:

Action.

Category:

Public health.

Title:

The introduction of a routine NHS varicella (chickenpox) vaccination programme for young children in Wales from 1 January 2026.

Date of expiry or review:

Not applicable

For action by:

• Chief executives, health boards or trusts.
• Immunisation leads, health boards or trusts.
• Immunisation coordinators, health boards.
• Vaccination operational leads, health boards or trusts.
• Medical directors, health boards or trusts.
• Directors of primary care, health boards or trusts.
• Nurse executive directors, health boards or trusts.
• Chief pharmacists, health boards or trusts.
• Directors of public health, health boards or trusts.
• National Director Health Protection and Screening Services and Executive Medical Director Public Health Wales.
• Head Vaccine Preventable Disease Programme, Public Health Wales.
• Director of Vaccine Delivery, Vaccination Programme Wales, NHS Executive.
• Community paediatricians, health boards.
• Heads of midwifery, health boards or trusts.
• Midwifery teams, health boards.
• Secondary care paediatricians, health boards.
• Consultant virologists, health boards.
• Health protection teams, health boards.
• General Practitioner Committee, Wales.
• General practitioners.
• Digital Health and Care Wales.

Sender:

Dr Keith Reid, Deputy Chief Medical Officer (Public Health).

HSSG Welsh Government contacts:

Vaccination Division,
Welsh Government,
Cathays Park,
Cardiff.
CF10 3NQ.
Email: wg.vaccinationsprogrammeteam@gov.wales

Dear Colleagues,

I am writing to inform you of a further significant change to the routine childhood vaccination schedule, which will start from 1 January 2026. A new Varicella (chickenpox) vaccine will be introduced to the childhood schedule, following recommendations by the Joint Committee on Vaccination and Immunisation (JCVI) as noted on GOV.UK.

We ask that you share this information with all parties involved in the planning, promotion and delivery of the vaccination programme in Wales. It is essential that you take appropriate action. The information and changes are complex and will require careful planning to ensure there are no gaps in vaccine protection.

Our previous Welsh Health Circular published on 22 May 2025, already set out the following changes to the childhood immunisation schedule from 1 January 2026:

• introduction of an additional (4th dose) of DTaP/IPV/Hib/HepB (hexavalent) vaccine at a new routine appointment at 18 months
• movement of the second MMR (Measles Mumps Rubella) dose from 3 years 4 months to the new routine 18-month appointment

In addition to the above changes, and in line with the statement made by the Cabinet Secretary for Health and Social Care on 29 August 2025, this circular confirms that varicella vaccination is also being introduced into the routine childhood immunisation schedule from 1 January 2026. This will be combined with the measles, mumps, and rubella vaccine into a single measles, mumps, rubella and varicella (MMRV) vaccine. This change means that children due their first or second MMR vaccine from 1 January 2026 will now be offered combined MMRV vaccine instead of MMR.

There will also be a selective catch-up programme from 1 November 2026 with MMRV for older children without a history of chickenpox or existing Varicella vaccination to help accelerate control and further to reduce transmission in the population.

Key information on implementing the routine and catch-up programmes for varicella vaccination from 1 January 2026:

1. Routine varicella programme – starting on 1 January 2026

The routine programme starting on 1 January 2026 will operate as follows (also see table below):

a. Two doses of MMRV offered to children aged under one year old on 31 December 2025 (Date of Birth on or after 1 January 2025): dose 1 at one year, and dose 2 at the new 18-month appointment.

b. Two doses of MMRV offered to children aged from one year up to 18 months on 31 December 2025 (Date of Birth on or after 1 July 2024 to 31 December 2024) at the new 18-month appointment and at the 3-year 4-month routine appointment. These children should have already received dose 1 of MMR at one year.

c. One dose of MMRV offered to children aged from 18 months up to 3-years 4-months on 31 December 2025 (Date of Birth on or after 1 September 2022 to 30 June 2024) at their 3-year 4-month routine appointment (instead of MMR). It is important that these children should have already received a first dose of MMR at twelve months, to ensure they still receive two MMR doses.

d. For the avoidance of doubt any child presenting with an incomplete immunisation history for their age should be managed according to the UKHSA (UK Health Security Agency) uncertain or incomplete immunisation algorithm noted on GOV.UK, which is being updated to reflect these changes.

Varicella selective catch-up programme, starting on 1 November 2026

A one-dose MMRV selective catch-up programme will be offered to any children aged over 3 years 4 months to under 6 years old on 1 January 2026 (Date of Birth 1 January 2020 to 31 August 2022) who have not had a chickenpox infection or two doses of varicella vaccination. There is no requirement for practices to check the history of chickenpox infection, for those who respond to the offer, by undertaking serology testing.

As stated above, children presenting for vaccination in this cohort, who may have missed routine doses of MMR, should be brought up to date using the UKHSA uncertain or incomplete immunisation algorithm noted on GOV.UK, which is being updated to reflect these changes.

Practices should accommodate eligible children taking up this offer between 1 November 2026 until 31 March 2028. Further detailed guidance on how the catch-up should operate will follow.

Information relevant to both routine and selective MMRV catch up programmes

The programmes will use two combined measles, mumps, rubella, varicella (MMRV) vaccines ProQuad® (MSD) and Priorix-Tetra® (GSK). The vaccines are interchangeable and offer clinically equivalent protection, however, Priorix-Tetra® is porcine gelatine free.

There is no ‘varicella-only’ vaccine offered in the routine childhood vaccination programme or selective MMRV catch up. Although, pre-existing arrangements remain in place for the provision of varicella-only vaccine for close contacts of those at high risk of complications from varicella infection, (such as siblings of a leukaemic child, or a child whose parent or sibling is undergoing chemotherapy) in line with Green Book guidance.

The MMR vaccine will no longer be available for the NHS routine childhood programme from 1 January 2026. The MMR vaccine will be available for uses outside of the routine childhood programme (such as catching up older individuals who have not received two-doses of MMR and are not eligible for varicella).

Children aged from 6 years and above at the start of the programme (Date of Birth 31 December 2019 or before) are not eligible for varicella vaccination via the routine NHS varicella programme.

There will be a small number of children in the catch-up group who will be eligible to receive three MMR-containing vaccines. There are no safety concerns with this approach.

Programme ambitions

Vaccination in childhood is one of the most important things we can do to protect our children against ill health. Receiving all scheduled vaccines levels the playing field for better outcomes and people in Wales living a longer, healthier and more productive life.

Recent decreases in childhood vaccination rates pose a significant public health risk, with outbreaks of preventable diseases such as measles and pertussis (whooping cough) already being seen.

It is therefore important that GPs use every opportunity to maximise the vaccination uptake in their eligible children. Practices should work closely with their health board teams to run an efficient and effective vaccination service.

There is a need for a coordinated, equity-focused approach to vaccination, which addresses barriers and the diverse needs of underserved communities to ensure we reach children who are unvaccinated or under vaccinated in the community. There has been some progress made across Wales in embedding equity into vaccination policy and practice, reflecting the ambitions of the national immunisation framework. However, inequalities in uptake persist and, in some areas, are worsening – most notably in children.

Equity needs to be built into the design and delivery of services, to promote universal accessibility, but with tailored interventions to understand and overcome the specific barriers faced by different population groups. The evidence tells us that with the right interventions and investment in services, underserved communities will accept the offer of vaccination, which points to accessibility rather than acceptability being the key barrier to inclusion and uptake.

Active call and recall is a core principle for childhood vaccination, however there are instances where this is simply not enough. Innovation and a determination to reach those who do not come forward will ensure that everyone gets an equitable opportunity to be protected. For example, taking every opportunity to check vaccination status and opportunistically catch-up children through other routine contacts, having appointments at convenient times and locations, and providing clear, concise information will help overcome some of these barriers and build trust.

Where issues with access or challenges persist with uptake, these should be escalated to health board level, with a system wide approach developed to overcoming them. Health boards are expected to step in where required to support practices who are experiencing difficulties in reaching the NHS performance framework target of 95% of children up to date with immunisations by five years old.

The Children and Young Persons Integrated System (CYPrIS) paved the way for the development of the Welsh Immunisation System (WIS) and as part of the National Immunisation Framework we continue to move toward a single vaccination record including childhood immunisation. Digital Health Care Wales is working at pace to develop this function. In the interim health boards and GPs should keep CYPrIS updated with accurate and timely vaccination information.

For any operational queries, please contact Vaccination Programme Wales by emailing VPW.Enquiries@wales.nhs.uk. For clinical queries or queries about programme resources, please email phw.vaccines@wales.nhs.uk.

I am very conscious that planning for these changes will need to be undertaken by teams at pace, and alongside preparations for other routine vaccinations in 2026. Your hard work and commitment in making all programmes a success is very much appreciated.

Yours sincerely,

Dr Keith Reid
Deputy Chief Medical Officer (Public Health)

Date of birth:

1 January 2025 or later.

Age on 31 December 2025:

Under 1 year.

New programme from 1 January 2026:

Two doses of MMRV at 12 months and 18 months.

Child’s full schedule for MMR or MMRV:

• 12 months: MMRV.
• 18 months: MMRV.

Date of birth:

1 July 2024 to 31 December 2024.

Age on 31 December 2025:

1 year to under 18 months.

New programme from 1 January 2026:

Two doses of MMRV at 18 months and 3 years 4 months.

Child’s full schedule for MMR or MMRV:

• 12 months: MMR.
• 18 months: MMRV.
• 3 years 4months: MMRV.

Date of birth:

1 September 2022 to 30 June 2024.

Age on 31 December 2025:

18 months to under 3 years 4 months.

New programme from 1 January 2026:

One dose of MMRV at 3 years 4months.

Child’s full schedule for MMR or MMRV:

• 12 months: MMR.
• 3 years 4 months: MMRV.

Date of birth:

1 January 2020 to 31 August 2022.

Age on 31 December 2025:

3 years 4 months to under 6 years.

New programme from 1 January 2026:

Selective catch-up from 1 November 2026 to 31 March 2028 for those who have not yet had chickenpox infection or two doses of varicella vaccination.

There is no requirement for practices to check the history for those who respond to the offer.

Child’s full schedule for MMR or MMRV:

• 12 months: MMR.
• 3 years 4 months: MMR.
• MMRV catch-up offer.

Date of birth:

31 December 2019 or before.

Age on 31 December 2025:

6 years and older.

New programme from 1 January 2026:

Not eligible.

Child’s full schedule for MMR or MMRV:

• 12 months: MMR.
• 3 years 4 months: MMR.

There is no requirement for practices to check the history for those who respond to the offer.

Note: Any child with an incomplete immunisation history for their age should be managed according to the UKHSA uncertain or incomplete immunisation algorithm noted on GOV.UK.

The Joint Committee on Vaccination and Immunisation (JCVI)

At its meeting in October 2023, the JCVI recommended that a universal 2-dose varicella (chickenpox) vaccination programme offering vaccination at 12 and 18 months of age using the combined MMRV (Measles, Mumps, Rubella and Varicella) vaccine be introduced into the routine childhood schedule, as noted on GOV.UK, and that this change should be aligned with the other childhood vaccination schedule changes in 2025 if possible.

Furthermore as noted in uploaded minutes on Box.com, at the February 2024 main JCVI meeting following additional cost-effectiveness analysis of a one-dose varicella catch up programme, the JCVI advised a universal varicella catch-up programme for all children aged up to and including 5 years. The committee also advised a targeted catch-up programme should be undertaken for children aged from 6 years and up to and including 10 years with no history of chickenpox infection (based on parental recall) or prior varicella vaccination.

In March 2025, following the outcome of the MMRV tender process, it was determined that the original JCVI recommendations were not feasible due to limited vaccine availability within the planned window of implementation. As noted in uploaded minuted on Box.com, the JCVI therefore advised a modified routine and catch-up (from 3 years 4 months up to 6 years) varicella programme based on the best use of available MMRV vaccine for public health at its June 2025 main committee meeting.

Funding and service arrangements

Routine NHS-funded childhood vaccinations in Wales, including the introduction of MMRV, are delivered as unified services under the General Medical Services (GMS) contract. The additional hexavalent dose (DTaP (Diptheria), IPV (Inactivated Poliovirus Vaccine), Hib (Haemophilus influenzae type b), HepB (Hepatitis B)) at 18 months will attract a new item of service fee as communicated in the previous Welsh health circular and the changes from MMR to MMRV will continue to be paid via the childhood immunisation target payment scheme agreed following consultation with GPC Wales. These changes will be reflected in the Directions to Local Health Boards as to the Statement of Financial Entitlements Directions 2013, and funding details will be shared with health board finance directors to support implementation. The selective catch-up which begins in November 2026 and attracts an item of service fee at the current rate which will be claimed via a specific national supplementary service.

Practices are expected to continue delivering routine vaccinations in line with national standards, including active call or recall systems. All relevant services must be informed and prepared for the changes outlined in this circular. Additionally, these updates will be incorporated into the Green Book, which provides clinical guidance and eligibility criteria for all vaccines in the UK immunisation schedule.

3. Digital support

CYPrIS (Children and Young Persons Integrated System) will be updated ready for 1 January 2026 to allow automated appointing and recording of vaccination with the revised schedule and the introduction of MMRV. Catch-up activity will be captured through existing routine appointments at 18 months and 3 years 4 months, which will be generated through CYPrIS. All children vaccinated as part of the selective catch-up must be recorded on CYPrIS.

4. Vaccine coverage data collection

In Wales, vaccine coverage data for the MMRV programme will be collected and reported by Public Health Wales Vaccine Preventable Disease Programme (VPDP) using the national COVER (Coverage of Vaccination Evaluation Rapidly) report scheme, which draws from the child health system. This approach ensures consistent monitoring of immunisation uptake across the country. Enhanced reporting will be implemented to ensure equitable coverage among children affected by the schedule changes, supporting data-driven service improvement and targeted interventions in communities with lower uptake.

5. Vaccine supply

The vaccines for the universal programmes will be available to order in the usual way online via the ImmForm website. Providers should ensure that local stocks of vaccine are rotated in fridges so that wastage is minimised. It is recommended that practices hold no more than two weeks’ worth of stock.

See Green Book chapter 3 on GOV.UK for more information on storage, distribution and disposal of vaccines: the green book, chapter 3 - GOV.UK.

Remaining MMR vaccine held in fridges can be used for any person with an incomplete immunisation history for their age should be managed according to the UKHSA uncertain or incomplete immunisation algorithm noted on GOV.UK. Where it is identified that they are not eligible for varicella vaccination. This product will continue to be available to order for this purpose.

Patient Group Directions (PGDs)

Updated UKHSA developed PGD templates will be made available for both MMR and MMRV as a reference resource for health boards to develop and authorise for use locally can be found on the Welsh Medicines Advice Service's page for Patient Group Directions (PGD).

7. Immunisation against infectious disease (the Green Book)

Public Health Wales' routine immunisation schedule noted on their website, outlines vaccine eligibility and is being updated to reflect the changes.

Detailed clinical guidance on varicella and MMRV vaccination will be covered in the following chapters of the Green Book:

• Measles: Chapter 21, on GOV.UK
• Mumps: Chapter 23, on GOV.UK
• Rubella: Chapter 28, on GOV.UK
• Varicella: Chapter 34, on GOV.UK

In addition, the following chapters will also be updated to align with the changes:

• UK Immunisation schedule: Chapter 11, on GOV.UK

8. Training and information resources for healthcare practitioners

Staff must be trained and competent to undertake activities within their scope of practice to support the vaccination programmes.

Training and information resources for Healthcare Practitioners will be made available on the Public Health Wales website.

9. Patient facing resources

Patient facing information resources will be made available on the Public Health Wales website under Immunisation and Vaccines.

Resources can be ordered for free at Health Information Resources on Public Health Wales' website.

10. Consent

Guidance on informed consent can be found in chapter 2 of the Green Book available on GOV.UK.

11. Reporting suspected adverse reactions

Healthcare professionals and those vaccinated are asked to report suspected adverse reactions through the online Yellow Card scheme noted on the Medicines and Healthcare Products Regulatory Agency's website by downloading the Yellow Card app or by calling the Yellow Card scheme on 0800 731 6789 9am to 5pm Monday to Friday.

12. Responding to vaccine incidents

Guidance for those involved supporting immunisation services to decide the appropriate response to vaccine incidents is on GOV.UK under Vaccine incident guidance: responding to vaccine errors.

13. Programme change evaluation

Vaccination Programme Wales within NHS Performance and Improvement is tasked with compiling an evaluation on the implementation of the changes within three months of 1 January 2026. This assurance reporting must encompass feedback sought from relevant stakeholders to foster continuous improvement and information made available to the NHS. Specific localised approaches to address inequity should also be evaluated and will need to feature in longer term assurance reporting.