Tetanus is a painful disease affecting the nervous system which can lead to muscle spasms, cause breathing problems and can kill. It is caused when germs found in the soil and manure get into the body through open cuts or burns. Tetanus cannot be passed from person to person.

Diphtheria is a serious disease that usually begins with a sore throat and can quickly cause breathing problems. It can damage the heart and nervous system, and in severe cases, it can kill.

Polio is a virus that attacks the nervous system which can cause permanent paralysis of muscles. If it affects the chest muscles or the brain, polio can kill.

Meningitis is inflammation of the lining of the brain, and can be the result of infection with a virus, bacteria, or other disease-causing organism, or as a result of injury. There are five main groups of meningococcal bacteria that can cause meningitis and septicaemia – A, B, C, W and Y. As well as meningitis, meningococcal infection can lead to septicaemia (blood poisoning), which is very serious, especially if not diagnosed early, and can lead to death. See page 10 for a full description of meningitis and septicaemia.

You may still have some protection, but you need these boosters to complete your routine immunisations and give you longer-term protection.

You need a total of five doses of tetanus, diphtheria and polio vaccines to build up and keep your immunity.

You should have had:

• the first three doses as a baby
• the fourth dose when you were between three and five years old, before you started school, and
• the fifth dose is due in year 9 (aged 13 to 14).

For protection against four groups (A, C, W and Y) of meningococcal infection, it is important to have one dose of MenACWY before you reach 19 years of age or if you are going to university for the first time.

You should have:

• The routine dose of MenACWY in year 9/10 (around 14 years)

You will probably not need further boosters of these vaccines. However, you may need extra doses of some vaccines if you are visiting certain countries. Check with your practice nurse at your surgery.

You will have two injections – one in each upper arm, or 2.5cm apart in the same arm. Nobody likes injections, but it is very quick. The needles used are small and you should feel only a tiny pinprick. If you are a bit nervous about having the injection, tell the nurse or doctor before you have it.

When you are having your Td/IPV, and MenACWY vaccines, it's a good idea to check with the nurse or doctor that all your other immunisations are up to date.

There are very few teenagers who may not have the HPV, Td/IPV, and MenACWY vaccines. You should talk to your doctor or school nurse if you are 'immunosuppressed' because you are having treatment for a serious condition such as a transplant or cancer, or you have a condition that affects your immune system, such as severe primary immunodeficiency.

If you have a minor illness without a fever, such as a cold, you should still have the immunisations. If you are ill with a fever, put the immunisations off until you have recovered. This is to avoid the fever being associated with the vaccines and the vaccines increasing the fever you already have.

If you have:

• had a bleeding disorder, or
• had convulsions (fits) not associated with fever speak to your doctor or nurse before having the immunisation.

It is common after injections to have pain, redness and swelling at the injection site. On very rare occasions side effects include fever, headache, dizziness, feeling sick, joint pains and swollen glands.

If you have any concerns don’t hesitate to contact your GP for advice.

If you feel unwell after the immunisation, take paracetamol or ibuprofen. Read the instructions on the bottle or packet carefully and take the correct dose for your age. If necessary, take a second dose four to six hours later. If your temperature is still high after the second dose, speak to your GP or call the free NHS helpline 111. It is not generally recommended that these medicines are given before or after vaccination in anticipation of a fever.

If you are aged under 16, you shouldn’t take aspirin or any medicine containing aspirin.

Meningitis is infection of the lining of the brain. The same germs that cause meningitis can cause septicaemia (blood poisoning). Meningitis and septicaemia are both very serious – they can cause permanent disability and death and the signs can come on quickly – so you must get treatment straight away. If you are 14 years or over, and have not been offered the MenACWY vaccine by your GP or school nurse, you should contact them and ask for it. You are eligible up to 19 years of age. Your GP or school immunisation provider will inform you if you are not sure. These vaccines do not protect against all the other bacteria and viruses that cause meningitis and septicaemia, so you still need to know the signs and symptoms.

Early symptoms of meningitis and septicaemia are mild and similar to those you get with flu (such as feeling hot, being sick, and pain in the back or joints). However, for meningitis, the most important signs to look out for are:

• a stiff neck
• a very bad headache (this alone is not a reason to get medical help)
• lights hurting your eyes
• vomiting
• a fever
• drowsiness, being less responsive or confused and
• red or purple spots that don’t fade under pressure (do the glass test explained on the next page).

For septicaemia, the most important signs to look out for are:

• sleepiness, being less responsive or confused (a late sign in septicaemia)
• severe pains and aches in the arms, legs and joints
• very cold hands and feet
• shivering
• rapid breathing
• red or purple spots that don’t fade under pressure (do the glass test explained below)
• vomiting
• a fever, and
• diarrhoea and stomach cramps

If you get one or more of the symptoms above, get help urgently. If you get treatment for meningitis and septicaemia quickly, you stand the best chance of making a full recovery. If you can’t get in touch with your doctor, or are still worried after getting advice, trust your own instincts and go to the emergency department of your nearest hospital or ask a friend to take you.

Press the side of a clear drinking glass firmly against the rash so you can see if the rash fades and loses colour under pressure. If it doesn’t change colour, contact your doctor immediately.