DTaP-IPV vaccine for children (4-in-1)

The vaccine gives protection against diphtheria, tetanus, whooping cough and polio.
Vaccine-preventable diseases

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To whom is the 4-in-1 vaccine administered?

The vaccine is administered as part of the national vaccination programme to 4-year-old children who have received the primary series of vaccinations.

Following THL’s instructions, it can also be used for booster vaccinations of those with insufficient protection up till the age of 14 years.

In case of an accident, the patient’s protection can be boosted with the 4-in-1 vaccine if necessary. 

The 4-in-1 vaccine of the national vaccination programme may only be used for vaccinations listed in the national programme. This way we can ensure that there is enough of the vaccine for the correct target groups, which are all 4-year-olds and children aged from 1.5 to 13 years whose vaccination protection is complemented following THL’s instructions. 

The 4-in-1 vaccine must not be used for booster vaccinations of children aged over 14 or adults.

Which vaccine is used and what does it contain?

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

  • The active substance contains
    • toxoids of diphtheria, tetanus and whooping cough bacteria, which are inactivated forms of the toxins produced by the bacteria 
    • surface structures of whooping cough bacteria
    • three different strains of inactivated whole polio viruses.
  • The adjuvant is an aluminium compound.
  • The excipients are sugar, salts, amino acids, vitamins and purified water.
  • The vaccine contains small amounts of 2-phenoxyethanol and formaldehyde as preservatives.

Dosage and schedule

The vaccine dose is 0.5 ml. In the national vaccination programme, a single dose of the vaccine is administered at the age of 4 years.

Please note:

  • The Tetravac vaccine included in the national vaccination programme may only be administered to 4-year-olds and children aged from 1.5 to 13 years whose vaccination protection is complemented following THL’s instructions. Tetravac must not be used for booster vaccinations of children aged over 14 or adults.
  • If the primary vaccinations have been delayed, an interval of two years should be left between the latest DTaP-IPV-Hib vaccine and a DTaP-IPV vaccine.
  • If a child aged under 5 years has not received all Hib vaccinations, the DTaP-IPV vaccine can be replaced with a DTaP-IPV-Hib vaccine.
  • If DTaP-IPV is administered as the primary vaccine, the schedule to be followed is 0, 2 and 6 months.

What are the contraindications and precautions associated with the vaccine?

The vaccine gives protection against four different pathogens. This is why it should not be missed without a compelling reason. If a contraindication that would prevent vaccination 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 4-in-1 vaccine which contains the tetanus component, even if the previous administration of a vaccine containing similar components had caused symptoms which, in the case of other vaccines, could be a contraindication for further vaccinations.

Postpone the vaccination if the patient has

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

What are the benefits of the 4-in-1 vaccine?

In young children, the vaccine reinforces the protection afforded by the 5-in-1 vaccine. The booster affords longer-lasting protection.

For those with insufficient or no protection afforded by vaccinations, the 4-in-1 gives protection against four different diseases: diphtheria, tetanus, whooping cough and polio.

Tetanus does not spread from person to person, which is why vaccinating other people is no protection against tetanus for a child. While the vaccine does not prevent infection, it helps the system defend itself against the toxin secreted by the tetanus bacteria. The 4-in-1 vaccine protects children 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. Before vaccinations were introduced, diphtheria was a significant cause of child mortality.

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.

Vaccinations administered to this age group also protect younger siblings, especially infants, who do not yet have full protection afforded by vaccinations. 

Thanks to the vaccination programme with a wide coverage, however, major whooping cough outbreaks no longer occur in Finland. The protection against whooping cough declines in about five years, however, which is why local outbreaks are possible. 

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. 

What are the potential adverse effects of the 4-in-1 vaccine?

The most common adverse effects are local reactions, a fever, headaches and irritability. The lymph nodes may also swell.

Redness, hotness, swelling, pain or rash symptoms at the injection site usually occur within a few days of the administration. 

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 local symptoms are very common after a 4-in-1 vaccination (DTaP-IPV). Extensive local reactions occur in 13% to 25% of vaccine recipients.

After 4-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 and generalised symptoms or swelling of the lymph nodes are not contraindications for further vaccinations. Fever and pain medication (ibuprofen, naproxen or paracetamol) can be used to relieve local and generalised symptoms.

Sterile abscesses at the injection site and serious adverse effects, including an anaphylactic reaction, are extremely rare.

History of the 4-in-1 vaccine in the national vaccination programme

The 4-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 a separate polio vaccine were used to vaccinate young children.

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