The 4-in-1 vaccine

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Overview

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

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 is 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 is 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.

Before the polio vaccine was introduced, there were as many as 8,000 cases in the UK during the polio epidemic. Because of the continued success of the polio vaccination, there have been no cases of paralytic polio in the UK for nearly 40 years (the last case was in 1984). Polio remains a threat with poliovirus traces found in London sewage in early 2022.

Being fully vaccinated is the best way to protect against becoming ill from polio. It's important to make sure you and your child are up to date with your vaccines.

More about polio

Why should my child be vaccinated?

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.

Who is eligible for the vaccine?

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

When will my child be immunised?

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

Most health boards run special immunisation clinics. If you can’t get to the clinic, contact your local health board to make another appointment.

Find out how to contact your health board regarding your child's vaccination appointment

What to do if you are unsure if you or your child has had all of their doses

Phone your GP surgery to check if you or your child has had all the required doses.

Your GP will check your records and be able to advise if it is clinically appropriate to receive the 4-in-1 vaccine.

To arrange a vaccine appointment, contact your local health board.

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

The vaccine

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

What vaccine is used?

The following vaccines are routinely used in Scotland:

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 shortened 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 effective is the vaccine?

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 get 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 a booster vaccination?

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 do we know the vaccine is 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.

After the vaccine

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

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

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

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.

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 also be used to treat a fever and other post-vaccination reactions. Read the instructions on the product packing very carefully. 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

Immediate action required: Phone 999 immediately if:

your child is having a fit

If you think your child might be seriously ill, trust your instincts and seek urgent medical advice.

Urgent advice: Phone your GP immediately if:

your child has a temperature of 39°C or above
your child still has a fever 48 hours after vaccination
if you're concerned about your child's health at any time

If your GP is closed, call NHS 24 on 111.

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 0800 731 6789 (available Monday to Friday, 9am to 5pm)

Vaccine Safety Net Member

Public Health Scotland is a proud member of the Vaccine Safety Net and partners with NHS inform to provide reliable information on vaccine safety.

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