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Diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type b (Hib) and hepatitis B (DTaP/IPV/Hib/HepB)(6-in-1) - Information for health professionals

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Background

Diphtheria, tetanus, pertussis (whooping cough), poliomyelitis, Hib (Haemophilus influenzae type b) and hepatitis B are notifiable diseases.

Diphtheria

Diphtheria is an acute infection usually affecting the nasopharynx caused by the bacterium Corynebacterium diphtheriae, and can affect all ages. The organism is spread by respiratory droplets and has an incubation period of two to five days.

Tetanus

Tetanus is an infection characterised by painful muscular contractions. It is caused by the bacterium Clostridium tetani and can affect any age. The organism is ubiquitous in the environment and has an incubation period from one day to several months.

Pertussis (whooping cough)

Pertussis is a respiratory infection characterised by sudden and severe spasms of coughing persisting for several weeks. It is caused by the bacterium Bordetella pertussis which can affect all ages, but is particularly severe in babies and infants, and can cause brain damage due to hypoxia during paroxysms of coughing. The organism is spread by direct contact or airborne respiratory droplets, and has an incubation period of 6 – 20 days.

Poliomyelitis

Polio (Poliomyelitis) is an infection characterised by the acute onset of flaccid paralysis. It is caused by Poliovirus type 1, 2 or 3, and can affect all ages. The organism is spread by the faecal-oral route and has an incubation period of 7 – 14 days.

Hib (Haemophilus influenzae type b)

Hib disease normally presents as meningitis or epiglottitis. It is caused by the bacterium Haemophilus influenzae type b, and mainly affects children under five years, but can affect any age. The organism is spread by respiratory droplets and has an incubation period of two to four days.

Hepatitis B

Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV) which affects all age groups. The organism is spread by blood to blood contact, sexual contact and by perinatal transmission from mother to child, and has an incubation period of 45 – 180 days.

The vaccine

In 2017 the UK replaced the ‘5-in-1’ vaccine with a ‘6-in-1’ vaccine. The ‘5-in-1’ vaccine protected against diphtheria, tetanus, pertussis, polio and Hib disease. The ‘6-in-1’ vaccine also gives protection against hepatitis B and was introduced for all UK babies born on or after 1st August 2017.

Infanrix hexa is an inactivated vaccine in a powder and suspension for reconstitution before injection. Vaxelis is an inactivated injectable vaccine in a pre-filled syringe presentation.

Infanrix hexa or Vaxelis can be used in the management of tetanus prone injuries in children under 10 who are not up to date with their primary course of tetanus containing immunisations.

Guidance on the treatment of tetanus cases and management of tetanus prone wounds can be is available at Tetanus: advice for health professionals.

Tetanus immunoglobulin should be administered concomitantly in accordance with official recommendations.

Summary of product characteristics

The Complete Routine Immunisation Schedule (PDF) includes information about routine and non-routine vaccinations.

 

Guidance

Vaccination programme recommendations from the Joint Committee on Vaccination and Immunisation (JCVI) and Welsh Government policy can be found at the links below.

Joint Committee on Vaccination and Immunisation - GOV.UK (read JCVI publications and statements; search e.g. polio)

Welsh Health Circulars and Welsh Government letters

Hexavalent vaccine for baby immunisation schedule (WHC/2017/039) | GOV.WALES

Attaining the WHO targets for eliminating hepatitis B and C (WHC/2017/048) | GOV.WALES

Children who have outstanding routine immunisations: national enhanced service specification (WHC/2017/021) | GOV.WALES

NES - Unscheduled Immunisations for Children and Young Adults

 

Training resources and events

Online courses and training materials about a number of vaccines and diseases can be accessed via the E-learning page.

Further immunisation training information and resources are provided on the Training Resources and Events page.

 

Clinical resources and information

Diphtheria – the green book, chapter 15

Tetanus – the green book, chapter 30

Pertussis - the green book, chapter 24

Polio – the green book, chapter 26

Haemophilus influenzae type b (Hib) - the green book, chapter 16

Hepatitis B - the green book, chapter 18

Hexavalent combination vaccine: programme guidance

Tetanus: advice for health professionals

Vaccination of individuals with uncertain or incomplete immunisation status

Patient group directions (PGDs) and protocols

PGD templates for vaccines can be found on the Patient group directions (PGDs) and protocols page.

Further clinical resources and information

 

Data and surveillance

Vaccination surveillance information can be found on the pages below: