The 4-in-1 vaccine

The 4-in-1 vaccine, also known as the DTaP/IPV or dTaP/IPV vaccine, helps protect your child against:

• diphtheria
• tetanus
• pertussis (whooping cough)
• polio

This vaccine's offered to children aged over 3 years 4 months at the same time as they receive the MMR vaccine. It's also used for a primary course of immunisation in children over 10 years old and adults.

The vaccine boosts the immunisations that were given to your child at 8, 12 and 16 weeks of age - boosting protection against diphtheria, tetanus, pertussis (whooping cough) and polio.

What's diphtheria?

Diphtheria's 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, can kill.

Diphtheria germs are spread from person to person through close contact.

What's tetanus?

Tetanus is a disease affecting the nervous system that can lead to muscle spasms, cause breathing problems and even kill.

It's caused when germs found in soil and manure get into the body through open cuts or burns. Tetanus can't be passed from person to person.

More about tetanus

What's pertussis (whooping cough)?

Whooping cough's a disease that can cause long bouts of coughing and choking, making it hard to breathe. Whooping cough can last for up to 10 weeks.

Babies under a year of age are most at risk from whooping cough. For these babies, the disease is very serious and can kill. It's not usually as serious in older children.

Whooping cough germs can be spread from person to person through close contact.

More about whooping cough

What's polio?

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

The polio virus is usually spread from person to person, or by swallowing contaminated food or water.

More about polio

The 4-in-1 vaccine, also known as the DTaP/IPV (dTaP/IPV) combined vaccine or the booster, is given as an injection.

Which vaccines are used?

The following vaccines are routinely used in Scotland:

• REPEVAX
• Infanrix IPV

What's a booster immunisation?

Booster immunisations are given to increase the protection already given by a primary immunisation. Sometimes the protection offered by a primary immunisation begins to wear off after a time. A booster dose extends the period of protection later into life.

How effective is the vaccine?

The illnesses caused by diphtheria can kill. Before the diphtheria vaccine was introduced in the UK, there were up to 70,000 cases of diphtheria a year, causing around 5,000 deaths.

The number of tetanus cases in the UK is low because of the effectiveness of the tetanus vaccine. Most people who got tetanus weren't immunised against it or didn't complete the entire immunisation schedule. 

Before the pertussis vaccine was introduced, on average 120,000 cases of whooping cough were reported each year in the UK.

Before the polio vaccine was introduced, there were as many as 8,000 cases of polio in the UK in epidemic years. Because of the continued success of the polio vaccination, there have been no cases of natural polio infection in the UK for over 20 years (the last case was in 1984).

What's the difference between dTaP/IPV and DTaP/IPV, and does the difference matter?

Diphtheria vaccines are produced in 2 strengths, depending on how much diphtheria toxoid (the toxin produced by the diphtheria bacteria that's been inactivated) they contain. The 2 strengths are abbreviated to ‘D’ for the high strength and ‘d’ for the low strength.

There are 2 vaccines available for use as the booster – one containing high-strength diphtheria (DTaP/IPV) and the other containing low-strength diphtheria (dTaP/IPV). Both vaccines have been shown to provide good responses, and so it doesn’t matter which one your child has for their booster.

How do we know the vaccine's safe?

All medicines (including vaccines) are tested for safety and effectiveness by the Medicines and Healthcare Products Regulatory Agency (MHRA). The vaccine meets the high safety standards required for it to be used in the UK and other European countries. The vaccine has been given to millions of people worldwide.

Once they're in use, the safety of vaccines continues to be monitored by the MHRA.

Your baby will get the DTaP/IPV or dTaP/IPV vaccination at your GP practice or health centre.

When's my baby going to be immunised?

Your baby will be offered the 4-in-1 vaccine at around 3 years and 4 months. Your local NHS Health Board will contact you to let you know about their arrangements for your baby's routine childhood immunisations.

Most practices and health centres run special immunisation baby clinics. If you can’t get to the clinic, contact the practice or health centre to make another appointment.

Improving how vaccines are offered in Scotland

To improve how vaccinations are offered to you or your child, you may notice:

• you're invited to a new location to receive your immunisations instead of your GP practice
• the health professional giving your immunisations changes

You'll still receive clear information about the location, date and time of your appointment.

After having the vaccine there may be side effects, but these are usually mild.

Side effects

Your child may have some redness, swelling or tenderness where they had the injection, but this will usually disappear in a few days. A hard lump may appear in the same place but this will also go away, usually over a few weeks.

Occasionally, children may:

• be unwell
• feel irritable
• develop a temperature, headache, swollen glands and feel sick

Infant paracetamol

Vaccines protect your baby against the risk of very serious infections and should not be delayed.

Fever can be expected after any vaccination.  Fevers are usually mild, so you only need to give a dose of infant paracetamol if your child isn’t comfortable or is unwell.  Read the instructions on the bottle very carefully. 

Fever is more common when the MenB vaccine is given with the other routine vaccines at 8 and 16 weeks.  Infant paracetamol should be given to babies after each of these immunisation appointments.

Public Health Scotland’s booklet What to expect after immunisations: Babies and children up to 5 years has more information.

In infants who do develop a fever after vaccination, the fever tends to peak around 6 hours after vaccination and is nearly always gone completely within 2 days. 

Ibuprofen can be used to treat a fever and other post-vaccination reactions.  Giving ibuprofen at the time of vaccination to prevent a fever is not effective.

Remember, never give medicines that contain aspirin to children under 16.

Information about treating a fever in children.

If an infant still has a fever 48 hours after vaccination or if parents are concerned about their infant’s health at any time, they should seek advice from their GP or NHS 111. 

The diseases vaccines protect against are very serious and therefore vaccination should not be delayed because of concerns about post-vaccination fever.

If you're worried about your child, trust your instincts. Speak to your GP or phone the 111 service.

Read more about the common side effects of immunisations that might occur in babies and young children up to 5 years of age.

Where can I report suspected side effects?

You can report suspected side effects of vaccines and medicines through the Yellow Card Scheme.

This can be done by:

• visiting the Yellow Card Scheme website
• phoning the free Yellow Card hotline on 0808 100 3352 (available Monday to Friday, 10.00am to 2.00pm)

Further information

If you’re unsure about anything, or have any questions about the 4-in-1 vaccine, phone:

• your GP practice
• the NHS inform helpline

Vaccine Safety Net Member

NHS inform is a proud member of the Vaccine Safety Net.

The Vaccine Safety Net is a global network of websites, evaluated by the World Health Organization, that provides reliable information on vaccine safety.

More about the Vaccine Safety Net

If you’re unsure about anything, or have any questions about the 4-in-1 vaccine, phone:

• your GP practice
• the NHS inform helpline

Immunisation leaflet

NHS Health Scotland have produced a leaflet explaining routine childhood immunisations in Scotland including the 4-in-1 vaccine, why it's offered and when it's given.

This leaflet's also available in Easy Read English and other languages - including Polish, Mandarin (Simplified Chinese) and Arabic.

Protecting your child

Protect your child against serious diseases (Leaflet)

Protect your child against serious diseases (Audio)

Protect your child against serious diseases (BSL)

After immunisation

What to expect after immunisations in babies and young children (Audio)

What to expect after immunisation: Babies and young children (Leaflet)

What to expect after immunisation: Babies and young children (BSL)