DTaP/IPV/Hib/HepB (6 in 1) vaccine - 6 in 1 vaccine information for health professionals

Background

Diphtheria, tetanus, pertussis (whooping cough), poliomyelitis, Hib (Haemophilus influenzae type b) and hepatitis B 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 five 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.

Hib (Haemophilus influenzae type b)

Haemophilus influenzae type b is a bacterium that can cause severe infections, mainly in children under five years, but can affect any age. The organism is spread by respiratory droplets and has an incubation period of two to four days.

Individuals can carry Hib bacteria in their nose and throat without showing signs of the disease. Before Hib vaccine was introduced, about four in every 100 pre-school children carried the Hib organism; after the vaccine was introduced, carriage rates fell below the level of detection.

Complications from Hib infection include meningitis, epiglottitis and pneumonia.

Hepatitis B

Hepatitis B is an infection of the liver caused by the hepatitis B virus (HBV) which affects all age groups.

The organism is spread by blood-to-blood contact, sexual contact and, by perinatal transmission from mother to child and has an incubation period of 45 – 160 days.

Many individuals newly infected with hepatitis B may experience sub-clinical or flu-like symptoms. Acute infection may lead to hepatic necrosis, which is often fatal.

The 6-in-1 vaccine

The 6-in-1 vaccine protects against diphtheria, tetanus, pertussis (whooping cough), poliomyelitis, Hib (Haemophilus influenzae type b) and hepatitis B, and was introduced for all UK babies born on, or after 1st August 2017.

The first three doses of Hib-containing vaccine are administered at 8, 12, and 16 weeks with the 6-in-1 (DTaP/IPV/Hib/HepB) vaccine.

Some of the links included in this information lead to content created by other organisations and may not be available in Welsh.

Changes to the childhood immunisation schedule for Wales and impact on the 6-in-1 vaccine

Menitorix© (Hib/MenC) was discontinued on 30 June 2025. Menitorix© was the fourth Hib vaccine dose in the routine schedule.

As a result of the cessation of Menitorix©, the Joint Committee on Vaccination and Immunisation (JCVI) who advise the UK government on vaccination matters, recommended changes to the childhood immunisation schedule for Wales.

The JCVI recommendations, include:

From 1 January 2026

An additional dose of Hib-containing multivalent vaccine (DTaP/IPV/Hib/HepB) given at 18 months of age. This is to replace the Hib previously given at 12 months (Hib/MenC).
The 18-month visit is a new appointment on the childhood immunisation schedule.

For more information about changes to the childhood immunisation schedule, including frequently asked questions, visit:

Where can I find more information about schedule changes to the routine childhood vaccination programmes?

You can find more information about schedule changes to the routine childhood vaccination programmes on our website.

About the vaccine

The 6-in-1 vaccine is marketed for use in the UK under the brand names Infarix hexa® and Vaxelis®.

Infanrix hexa® is an inactivated vaccine in a powder and suspension for reconstitution before injection. Vaxelis® is an inactivated injectable vaccine in a pre-filled syringe presentation.

Guidance on the treatment of tetanus cases and management of tetanus prone wounds can be is available at:

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.

Guidance in the Green Book supersedes the Summary of product characteristics (SmPC). 

Reporting side effects

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. 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.

Guidance on changes to the childhood immunisation schedule in Wales

Changes to the childhood immunisation schedule: JCVI statement

The Complete Routine Immunisation Schedule for Wales is available on our website and includes information about routine and non-routine vaccinations.

Policy and guidance can also be found on the Public Health Wales Policy, letters and Welsh Government SharePoint page (access for NHS healthcare staff)

Guidance for health professionals on the treatment and reduction of cases of hepatitis. Eliminating hepatitis (B and C) as a public health threat: actions for 2022 to 2023 and 2023 to 2024 (WHC/2023/001)

Letter to health boards on the actions they need to take to make progress on hepatitis B and C elimination. Written Statement: Eliminating hepatitis B and C as a public health threat (3 February 2023)

Children and adults who have outstanding routine immunisations: national supplementary service specification

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

Clinical resources and information

Patient group directions (PGDs) and protocols

PGD templates for vaccines 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

Data and surveillance

Vaccination surveillance information can be found on the pages below:

Page last reviewed: 22nd April 2026