Immunization – DTP, polio, hep B and Hib

Several combined immunizations protect against diphtheria, tetanus, whooping cough and other infectious diseases at different life stages. Diphtheria, tetanus, whooping cough (pertussis) — often shortened to DTP — along with polio, hepatitis B and Hemophilus influenzae type b (Hib) are six infectious diseases that are particularly dangerous to babies.

Combined immunizations allow maximum protection to begin as soon as possible after birth. They also reduce the number of injections needed, which is especially helpful for babies and children.

How combined vaccines are used#

Some types of immunization work after only one dose. Others — such as those for diphtheria, tetanus and whooping cough — need a primary course followed by booster doses over time.

Schedules vary from country to country, but the general pattern is similar:

• A six-in-one vaccine (diphtheria, tetanus, whooping cough, polio, hepatitis B and Hib) is usually given as a primary course of injections during infancy. Catch-up doses are available for older children who were not immunized on time.
• These doses also complete much of the hepatitis B course, where a first dose is often given shortly after birth.
• A booster dose covering Hib is given in the second year of life.
• A four-in-one vaccine (diphtheria, tetanus, whooping cough and polio) is given as a booster in early childhood, and as catch-up for older children who missed it.
• A three-in-one vaccine (diphtheria, tetanus and whooping cough) is used as a booster in the second year of life.
• A reduced-antigen three-in-one (dTpa) vaccine is used for boosters and catch-up immunization in older children, adolescents and adults, including some groups at higher risk.

Protection against diphtheria, tetanus and whooping cough fades with age, so booster doses of the combination vaccine are recommended for older adults to maintain protection. A prescription from your doctor may be needed.

Immunization in pregnancy#

A reduced-antigen three-in-one (dTpa) vaccine against diphtheria, tetanus and whooping cough is recommended during every pregnancy, to protect both the mother and the newborn baby from whooping cough. If it is not given before delivery, it is recommended as soon as possible afterwards.

This vaccine is also recommended for a pregnant woman who has a wound that could lead to tetanus, and it can be given while breastfeeding. Speak with your doctor about the timing that is right for you.

Side effects#

Vaccines against diphtheria, tetanus, whooping cough and other infectious diseases (including the six-in-one, four-in-one and three-in-one vaccines) are effective and safe, although, like all medicines, they can have unwanted side effects. These are usually uncommon and mild, and may include:

• Children being unsettled, irritable, tearful or generally unhappy
• Drowsiness or tiredness
• Muscle aches (more likely when the vaccine also contains polio)
• Localized soreness, redness, itching or swelling at the injection site for a day or two
• A low-grade fever

Most reactions are mild and short-lived, occurring in the first one to two days after vaccination. Extremely rare side effects include a severe allergic reaction.

Booster doses given in early childhood are occasionally followed by extensive swelling of the vaccinated arm, from shoulder to elbow, which clears completely within a few days. Sometimes a small, hard lump (nodule) at the injection site lasts for some weeks or months. This is not a cause for concern and needs no treatment.

Managing side effects#

Specific treatment is not usually required. Steps that can ease side effects include:

• Offering extra fluids to drink
• Not overdressing a child or baby who is hot
• A cool compress on a sore injection site

Routine use of paracetamol after vaccination is not recommended, but if a fever is present, paracetamol can be given. Check the label for the correct dose, or ask your pharmacist — especially when giving it to children.

When to seek advice#

If a reaction after immunization is unexpected, persistent or severe, or if you are worried about yourself or your child, see your doctor or immunization nurse as soon as possible, or go directly to a hospital. It is also worth seeking advice if you or your child are unwell, as this may be due to another illness rather than the immunization.

There is a very small risk of a serious allergic reaction (anaphylaxis) to any vaccine. This is why you are asked to stay at the clinic for at least 15 minutes after immunization, in case further treatment is needed. Significant reactions can be reported to your local adverse events reporting service.

The immunizations you may need depend on your health, age, lifestyle and occupation. Talk to your doctor or immunization provider if you think any of these factors mean an immunization is necessary for you or someone in your care.

Key points#

• Combined vaccines protect against several dangerous diseases while reducing the number of injections.
• Some diseases need only one dose; diphtheria, tetanus and whooping cough need a primary course plus boosters.
• A dTpa vaccine is recommended in every pregnancy to protect mother and newborn from whooping cough.
• Specific treatment is not usually required for side effects, which are generally mild and short-lived.
• There is a very small risk of a serious allergic reaction (anaphylaxis) to any vaccine.

Where to get help#