DTP/Polio/Hib Immunisation

What is the DTP/Polio/Hib vaccine?

DTP stands for Diphtheria, Tetanus and Pertussis. Polio is short for poliomyelitis. Hib stands for Haemophilus influenza b. The vaccines for these five diseases are combined into one injection.

Timetable for DTP/Polio/Hib immunisation

• Babies are offered the 'primary course' of DTP/Polio/Hib. This consists of a first dose of vaccine at the age of two months. Then a second dose four weeks later at the age of three months. Then a third dose four weeks later at the age of four months.
• Each dose of the primary course of DTP/Polio/Hib is usually given at the same time as the MenC vaccine and/or the Pneumococcal vaccine (given with separate injections).
• A booster fourth dose of Hib is offered at around 12 months. This is combined with the MenC vaccine as a single injection.
• A booster dose of DTP/Polio without the Hib is offered three years after the third dose of the primary course. This is a 'pre-school' booster. It is usually given at the same time as the MMR 'pre-school' booster (which is given by a separate injection).
• A booster dose of Tetanus, Diphtheria and Polio (DT/Polio without pertussis or Hib) is also offered at aged 13-18. This is sometimes called the teenager or 'school leaver' booster.

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.

Note: when Hib was first introduced in the UK in 1992 it had to be given as a separate injection to DTP. Also, prior to October 2004, polio immunisation used to be given separately as drops into the mouth. They are now all combined into one injection - the 'five-in-one' vaccine.

Who should NOT receive DTP/Polio/Hib vaccine?

• The vaccine should not be given if you have had a severe reaction to a previous dose (rare). Also, if you have had a previous severe (anaphylactic) reaction to neomycin, streptomycin or polymyxin B as tiny amounts of these antibiotics may be present in the vaccine.
• A dose of vaccine may be postponed if a child has a significant infectious illness.
• There is no reason to postpone a dose of vaccine if a child has a minor infection such as a cough, cold or snuffles.

• Slight swelling and redness at the injection site is common.
• A little area of hard skin may form at the injection site which usually disappears in time.
• Sometimes a fever occurs a few hours after the injection and the child may become irritable.
• Serious reactions are very rare.

If necessary, you can give a child paracetamol or ibuprofen to ease pain and fever. Occasionally, a baby may cry or be irritable for a few hours following immunisation. If this appears to be extreme or lasts more than a few hours (uncommon), seek a doctor's advice.

How serious are the diseases prevented by DTP/Polio/Hib vaccine?

Diphtheria
This is a serious infection of the throat and lungs caused by the bacterium Corynebacterium diphtheriae. The bacteria also make a poison (toxin) which can affect the heart and nervous tissue. Introduction of the immunisation in 1940 reduced this illness dramatically. In 1940 there were 46,281 reported cases in the UK with 2,480 deaths. By 1957 there were 37 reported cases and 6 deaths and from 1986-1991 there were only 13 cases reported.

Tetanus
This is an infection caused by a bacterium called Clostridium tetani. It is a serious illness which attacks the nervous system which can produce spasm of muscles often leading to 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 sufficient tetanus bacteria to be lethal. Tetanus is not transmitted from person to person and needs a cut in the skin to get into the body. Deaths from tetanus in the UK are mainly in people over the age of 50 years who have not been immunised as immunisation was introduced in the 1950s.

Pertussis (whooping cough)
This 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 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 1950's the rate fell dramatically to about 2,000 cases a year.

Polio
Polio (poliomyelitis) 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 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 rare in the UK because of the success of immunisation.

Haemophilus influenza
Different types of the Haemophilus bacterium cause infections such as ear infections and chest infections. However the Haemophilus influenza type B (Hib) is a particularly nasty type. This can cause meningitis and epiglottitis (a very serious disease of the throat). 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 four years they become uncommon again. So, the 'at-risk' time for infections caused by Hib is from three months to four years.

Further information

Information on immunisation
www.immunisation.org.uk
From the NHS aimed at the general public.

Immunisation Against Infectious Disease (The Green Book)
www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/GreenBook/fs/en
From the Department of Health. Aimed at health professionals but of interest to all.

© EMIS and PIP 2006   Updated: October 2006