DTaP-IPV-Hib vaccine for children (5-in-1)

The vaccine gives protection against diphtheria, tetanus, whooping cough, polio and serious infections caused by Hib bacteria.
Vaccine-preventable diseases

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To whom is the 5-in-1 vaccine administered?

The vaccine is administered to young children as part of the national vaccination programme. It is suitable for children up to the age of five years.

It can also be used to vaccinate stem cell transplant recipients of all ages.

Which vaccine is used and what does it contain?

The product used in the vaccination programme is called Pentavac. It does not contain live pathogens.

  • The active substance in the vaccine contains
    • toxoids of diphtheria, tetanus and whooping cough bacteria, or inactivated forms of the toxins produced by the bacteria
    • surface structures of whooping cough bacteria
    • three different strains of inactivated whole polio viruses 
    • surface sugars of Haemophilus influenzae type b bacteria
  • The adjuvant is an aluminium compound.
  • The excipients are sugar, salts, amino acids, vitamins and purified water.
  • The preservatives are phenoxyethanol and ethanol.

In addition to a powder ampoule, Pentavac vaccine packs contain a fixed-needle syringe pre-filled with a single dose. Using the fixed-needle syringe for administering the vaccine is not recommended. Once the vaccine has been reconstituted, the syringe needle will be wet, and the adjuvant may cause irritation when it ends up in the subcutaneous tissue. The vaccine should be aspirated into a new syringe, using a dry needle for administration.

Dosage and schedule

The vaccine dose is 0.5 ml. THL recommends vaccinating children at the ages of 3, 5 and 12 months. If this is not possible, remember the following rules: 

  • the interval between the first and second dose should be 2 months
  • the interval between the second and third dose should be 4 months
  • if the vaccinations need to be brought forward, for example because of foreign travel, the vaccination series can be started already at the age of 6 weeks. In this case, the interval between the first and the second dose must be at least 8 weeks. The third dose is normally administered at the age of 12 months.

What are the contraindications and precautions associated with the vaccine?

The 5-in-1 is an important vaccine for children as it protects them against five different pathogens. This is why the vaccination series should not be interrupted without a compelling reason. If a contraindication that would prevent further vaccinations is suspected, the physician in charge of vaccination safety at the Finnish Institute for Health and Welfare should be consulted.

Everyone needs protection against tetanus, which is a life-threatening disease. This is why an effort is always made to administer the 5-in-1 vaccine which contains a tetanus component even if the previous administration had caused symptoms which, in the case of other vaccines, might be a contraindication for further vaccinations.

Postpone the vaccination if the patient has

  • a fever or a febrile infection
  • an undiagnosed seizure disorder or some other progressive neurological condition.

What are the benefits of the 5-in-1 vaccine?

The 5-in-1 vaccine protects children against five different diseases as well as the secondary diseases and complications associated with them. 

Tetanus does not spread from person to person, which is why other people’s vaccinations give no protection against this disease to a child. 

While the vaccine does not prevent infection, it helps the system defend itself against the toxin secreted by the tetanus bacteria. The 5-in-1 vaccination series gives children good protection against life-threatening tetanus infections. 

In addition, proper wound care is also essential in tetanus prevention. 

While the vaccine does not prevent the spread of diphtheria, it gives excellent protection against serious symptoms. The vaccine helps the system defend itself against the toxin secreted by the diphtheria bacteria. 

The vaccine gives protection against whooping cough, which is a highly contagious disease. At the same time, it protects children against the secondary diseases and complications of whooping cough, which include 

  • pneumonia and middle ear infections
  • convulsions
  • apnoea, cerebral hypoxia (lack of oxygen in the brain), brain injuries and death. 

Thanks to vaccinations administered to children and young adults, large outbreaks of whooping cough no longer occur in Finland. Local outbreaks continue to crop up, however, and they may be life-threatening for young children who are unprotected or not fully protected. 

Protection against polio is necessary, especially when travelling to areas with polio epidemics, but the increase in tourism and immigration means that contracting polio is also possible in Finland. The vaccine effectively prevents the most severe problems caused by the polio virus, which include paralysis in limb and respiratory muscles. 

The 5-in-1 vaccine protects young children against serious infections caused by the Hib bacterium, including 

  • meningitis
  • sepsis
  • epiglottitis (throat infection) leading to blockage of the respiratory tract
  • pneumonia
  • bacterial arthritis or osteomyelitis (inflammation of joints or bones).

Before Hib vaccinations of young children were started, 150 to 200 children contracted serious Hib infections in Finland every year. 

The vaccine prevents pharyngeal carriage of Hib bacteria, and vaccinations thus stop the bacteria from spreading from person to person. A high vaccination coverage has all but eradicated Hib infections in Finland. 

What are the potential adverse effects of the 5-in-1 vaccine?

Local symptoms at the injection site

In different studies, children's 5-in-1 vaccines (DTaP-IPV-Hib) have caused swelling, redness or pain at the injection site in a few per cent of the vaccinated children within a few days of administration. 

Extremely large local reactions extending to the closest joint or beyond it are rare.

The occurrence of local reactions is influenced by the number of previous vaccine doses containing the same components (D, T or aP) the recipient has had. This is why they are more common in connection with the second or third dose.

After 5-in-1 vaccine administration in a lower limb, the child may sometimes avoid putting weight on the leg, be unwilling to walk, or limp. It is believed that these transient symptoms result from local pain caused by the vaccine.

Local symptoms at the injection site are not a contraindication for further vaccinations.

Fever and pain medication (ibuprofen, naproxen or paracetamol) can be used to relieve local reactions.

Fever and other generalised symptoms

Within a few days of the vaccination, a child may be irritable, have pain or a fever, cry or sleep more than usual, or have other transient symptoms and swelling in the lymph nodes. 

Less than one per cent of vaccinated children develop a high temperature (over 39 degrees). 

Generalised symptoms and swelling in the lymph nodes are not a contraindication for further vaccinations.

Fever and pain medications (ibuprofen, naproxen or paracetamol) can be used to relieve transient generalised symptoms.

Rare adverse effects

  • A sterile abscess sometimes appears at the injection site. This is not a contraindication for further vaccinations. 
  • Febrile convulsions occurring after a 5-in-1 vaccination are rare, and they are not a contraindication for further vaccinations.
  • Other convulsions and poor muscle tone resembling loss of consciousness (hypotonic-hyporesponsive episode, HHE) are rare. HHE is not a contraindication for further vaccinations.
  • Discolored leg syndrome has been described as a rare adverse effect. This means a sudden swelling and change in skin colour in the lower limbs. It is not a contraindication for further vaccinations.
  • Urticaria (hives) and different skin reactions may occur following a 5-in-1 vaccination. They are not usually a contraindication for further vaccinations, as the skin symptoms are often caused by reasons other than an actual reaction to the vaccine.

History of the 5-in-1 vaccine in the vaccination programme

The 5-in-1 vaccine was introduced in Finland's national vaccination programme following a reform carried out in 2005. Before this, a 3-in-1 vaccine (DTwP) produced by the National Public Health Institute and separate polio and Hib vaccines were used.