dTaP/IPV (4 in 1) vaccine - 4 in 1 vaccine information for health professionals

Background

Diphtheria, tetanus, pertussis (whooping cough) and poliomyelitis are notifiable diseases.

Diphtheria

Diphtheria is an acute infection usually affecting the nasopharynx caused by the bacterium Corynebacterium diphtheriae and can affect all ages.

The organism is spread by respiratory droplets and has an incubation period of two to ten days. Patients with untreated disease may be infectious for up to four weeks, but carriers may potentially transmit the infection for longer.

Diphtheria in the upper respiratory tract is characterised by:

membranous pharyngitis (pseudo-membrane), which may cause respiratory obstruction.
fever
swollen lymph nodes in the front on the neck and swelling of soft tissues which can lead to a “bull neck” appearance.

Tetanus

Tetanus is an infection characterised by painful muscular contractions. It is caused by the bacterium Clostridium tetani and can affect any age.

The organism is found everywhere in the environment and has an incubation period from four and 21 days.

The disease is characterised by generalised rigidity and spasms of skeletal muscles. The muscle stiffness usually involves the jaw (lockjaw) and neck and then becomes generalised.

The case–fatality ratio ranges from 10 to 90%; it is highest in infants and the elderly. Tetanus can never be eradicated because the spores are commonly present in the environment, including soil. Tetanus is not spread from person to person.

Pertussis (whooping cough)

Pertussis is a respiratory infection characterised by sudden and severe spasms of coughing persisting for several weeks. It is caused by the bacterium Bordetella pertussis which can affect all ages, but is particularly severe in babies and infants, and can cause brain damage due to hypoxia during paroxysms of coughing.

The organism is spread by direct contact or airborne respiratory droplets and has an incubation period of six to 20 days.

The disease begins with a build-up of phlegm (catarrh), followed by an irritating cough that becomes paroxysmal within one to two weeks. Paroxysms often lead to a ‘whoop’ or vomiting. In young infants, the ‘whoop’ might not appear. Older children and adults may experience a persistent cough without classic symptoms.

Poliomyelitis

Polio (Poliomyelitis) is an infection characterised by the acute onset of flaccid paralysis. It is caused by Poliovirus type 1, 2 or 3, and can affect all ages.

The organism is spread by the faecal-oral route and has an incubation period of three to 21 days.

Symptoms range from fever to aseptic meningitis or paralysis. Other possible symptoms include headache, gastrointestinal disturbance, malaise, and neck and back stiffness, with or without paralysis.

About the 4-in-1 vaccine

The 4-in-1 is offered routinely at three years and four months of age, and for children up to ten years of age who have not received it.

The 4-in-1 vaccine is marketed for use in the UK under the brand names REPEVAX® and Boostrix-IPV®. Both vaccines are clinically equivalent.

REPEVAX® and Boostrix-IPV® are injectable vaccines in a pre-filled syringe presentation. They contain a reduced amount of acellular diphtheria, tetanus and pertussis antigens and inactivated poliomyelitis antigens.

Please note: The primary vaccine used for the pre-school booster diphtheria, tetanus, acellular pertussis and polio (dTaP/IPV) vaccination is now REPEVAX®.

Summary of product characteristics

More information about the vaccine can be found in the Green Book chapters for each disease. See Clinical resources and information section.

Reporting side effects

Reporting suspected adverse reactions after vaccination is important. It helps monitor the safety and benefits of the medicine. You should report suspected adverse reactions of vaccines and medicines online at Yellow Card, by downloading the Yellow Card app, or by calling 0800 731 6789 (Monday to Friday, 9am to 5pm).

Guidance

Vaccination programme recommendations from the Joint Committee on Vaccination and Immunisation (JCVI) and Welsh Government policy can be found at the links below.

Joint Committee on Vaccination and Immunisation – read JCVI publications and statements; search e.g. polio.

Welsh Health Circulars and Welsh Government letters

Public Health Wales

The Complete Routine Immunisation Schedules for Wales includes information about routine and non-routine vaccinations.

Training resources and events

Online courses and training materials about a number of vaccines and diseases can be accessed via the E-learning page.

Further immunisation training information and resources are provided on the Training Resources and Events page.

Clinical resources and information

Patient group directions (PGDs) and protocols

Vaccine PGD templates and Advisory Documents for Wales can be found on the Welsh Medicines Advice Service page. 

Further clinical resources and information

Vaccine resources for health and social care workers

More information

British Polio Fellowship

Data and surveillance

Vaccination surveillance information can be found on the pages below:

Page last reviewed: 21st April 2026