The 6-in-1 vaccine protects your baby against six different serious illnesses. Three doses are given. Further boosters without all six components are given at other times later in childhood and in adult life. The 6-in-1 vaccine used to be given as the 3-in-1 vaccine DTaP along with the polio vaccine which was given by mouth, but has gradually been extended so that it now protects your baby against even more diseases. It is given in one single injection into the thigh from one single syringe.
This leaflet explains when this vaccine is given and why. It also explains which components of the 6-in-1 vaccine are given later in the UK immunisation schedule as the 4-in-1, 3-in-1 etc.
What is the 6-in-1 vaccine?
The 6-in-1 vaccine is a combination vaccine, also known as the DTaP/IPV(polio)/Hib/Hep B vaccine, or the hexavalent vaccine. Let's look at these six components:
- 1, 2 and 3: DTaP stands for diphtheria (D), tetanus (T) and acellular pertussis (aP) (whooping cough).
- 4: polio is short for poliomyelitis. IPV stands for 'inactivated polio vaccine'.
- 5: Hib stands for Haemophilus influenzae type b.
- 6: Hep B stands for hepatitis B.
The vaccines to protect against these six diseases are combined into one injection.
This is a combination vaccine which does not contain any live germs (organisms) so cannot cause any of the diseases it is protecting against.
Before 2004, polio vaccine used to be given as drops into the mouth. Polio vaccine is now always given as an injection.
When is the 6-in-1 vaccine given?
Babies are offered the 'primary course' of the 6-in-1 vaccine. Three doses are given.
- A first dose of vaccine at the age of 2 months.
- A second dose four weeks later at the age of 3 months.
- A third dose four weeks later at the age of 4 months.
Further boosters for children
An extra fourth booster of Hib is offered at between 12 and 13 months. This is combined with the first vaccination against meningitis C (MenC) as a single injection.
The 4-in-1 vaccine
A booster dose of DTaP/IPV(polio) (without the Hib) is offered three years after the third dose of the primary course (at age 3 years and four months to 5 years). This is a 'preschool' booster. It is now a 4-in-1 injection.
The 3-in-1 vaccine
A booster dose of tetanus/diphtheria and polio (Td/IPV(polio)) - without whooping cough (pertussis) or Hib - is also offered at age 13-18 years. This is sometimes called the teenager or 'school leaver' booster. It is now a 3-in-1 injection.
If your child has not had their routine immunisations at the correct time, they can usually 'catch up'. Doses and timings of 'catch-up' can vary, depending on age and previous immunisations. Your doctor or practice nurse will advise you about this.
Most of these injections above are given along with others as part of the immunisation schedule.
Further boosters for adults
Since September 2012 the DTaP/IPV(polio) vaccine has also been offered to all pregnant women between 28 and 38 weeks of pregnancy. This vaccination programme aims to boost the short-term immunity passed on by pregnant women to their newborn babies who normally cannot be vaccinated themselves until they are 2 months old.
Anyone who has had all five doses of the tetanus vaccination as part of the routine childhood immunisation schedule should not need any more. However, boosters may be given if this is not the case, if it is not known, or if you have a particularly high-risk injury. If this is the case, the vaccine is given as Td/IPV(polio), ie tetanus and polio only. See the separate leaflet called Tetanus Immunisation for more details.
Who should NOT receive 6-in-1 vaccine?
- The vaccine should not be given if your baby has had a severe reaction to a previous dose. Also, if they have had a previous severe (anaphylactic) reaction to any of the components of the vaccine, such as formaldehyde, neomycin, or polymyxin B, as tiny amounts of these may be present in the vaccine.
- A dose of vaccine may be delayed if your child is ill with a high temperature (fever).
There is no reason to delay a dose of vaccine if your child has a minor infection, such as a cough, cold or snuffles.
Premature babies should still have the vaccines at the normal age.
Are there any side-effects from the 6-in-1 vaccine?
Generally speaking very mild reactions are common, but it is rare to have a severe side-effect.
- Slight swelling and redness at the injection site are common.
- A little area of hard skin may form at the injection site, which usually disappears in time.
- Sometimes, a high temperature (fever) occurs a few hours after the injection and the baby may become irritable.
- Occasionally the baby may have some mild diarrhoea and/or vomiting.
- Serious reactions are extremely rare.
If necessary, you can give a child paracetamol or ibuprofen to ease any pain and fever if your child seems distressed. Occasionally, a baby may cry or be irritable for a few hours following immunisation. If this appears to be extreme, or lasts for more than a few hours, you should seek a doctor's advice.
How serious are the diseases prevented by the 6-in-1 vaccine?
The 6-in-1 vaccine protects your baby against some very serious diseases. Furthermore, the more people are protected, the less the number of people who can get the disease and spread it to others. Because of our routine immunisation schedule, these nasty diseases are all now uncommon in the UK. The vaccines have saved countless lives. So it is very important that your baby is protected.
Diphtheria is a serious infection of the throat and lungs caused by the germ (bacterium) Corynebacterium diphtheriae. The bacteria also make a poison (toxin) which can affect the heart and nervous tissue. The introduction of this immunisation in 1940 reduced this illness dramatically. In the UK, diphtheria is now extremely rare.
Tetanus is an infection caused by a bacterium called Clostridium tetani. It is a serious illness which can attack the muscles and nervous system. It can be very serious and even result in death. The bacteria which cause tetanus live in the soil. Most infections are caught from cuts, particularly dirty wounds. Even tiny cuts, such as thorn scratches, can introduce tetanus bacteria into the body. Tetanus is not transmitted from person to person and needs a cut in the skin to get into the body. Tetanus in the UK is uncommon and occurs mainly in people over the age of 65 years who have not been previously immunised against tetanus, as the immunisation was introduced in the 1950s.
Whooping cough (pertussis)
Whooping cough is a highly infectious disease caused by a bacterium called Bordetella pertussis. It is passed from person to person by coughing. It causes a distressing and prolonged coughing illness which can lead to complications causing pneumonia, brain damage and even death. Before immunisation was introduced there were often over 100,000 cases per year in England and Wales. After it was introduced in the 1950s, the rate fell dramatically. See the separate leaflet called Whooping Cough for more information.
Polio is a serious illness caused by the polio virus. The virus first infects the gut but then travels to the nervous system and can cause a meningitis-like illness. This can sometimes leave permanent damage to some nerves. This can lead to wasting of some muscles and can sometimes cause paralysis of the arms or legs. The illness can seriously affect breathing in some people and may lead to death. In 1955, before the introduction of polio immunisation, there were nearly 4,000 reported cases of polio in England and Wales. Polio is now extremely rare in the UK because of the success of immunisation.
Different types of the haemophilus bacterium cause infections such as ear infections and chest infections. However, Haemophilus influenzae type b (Hib) is a particularly nasty type. This can cause meningitis and a very serious disease of the throat (called epiglottitis). It can also cause infective arthritis, infection in bones and pneumonia. Serious illnesses caused by Hib are uncommon under the age of three months. Unless immunised, they become more common towards the first birthday. After the age of 4 years they become uncommon again. So, the 'at-risk' time for infections caused by Hib is from 3 months to 4 years.
The hepatitis B virus causes infection of the liver. It is caught from infected blood or body fluids. It can cause serious liver damage. Read more about it in the separate leaflet called Hepatitis B.
There is also a separate vaccination which just protects against hepatitis B alone. This is available for people at high risk who were not vaccinated as babies. See the separate leaflet called Hepatitis B Vaccine for more information.
Hepatitis B was only recently included in the routine childhood vaccination schedule in the UK, in 2017.
Further reading and references
Immunisation against infectious disease - the Green Book (latest edition); Public Health England
Whooping Cough Vaccination Programme for Pregnant Women; Dept of Health (2012)
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