The 6-in-1 vaccine

This vaccine protects children against 6 different infections/diseases, and is usually given as three separate injections, with at least 1 month between each dose.
Within the Irish vaccination schedule, the 6-in-1 vaccine is administered to babies when they are 2,4 and 6 months old, and booster doses against some of these infections are given to children when they are 4-5 and 11-14 years old (your doctor will advise you if you require a different schedule of immunisation to that suggested by the HSE).

The 6-in-1 vaccine provides protection against:

    1.  Diphtheria

    2.  Tetanus

    3.  Whooping cough (Pertussis)

    4.  Hepatitis B

    5.  Polio

    6.  Haemophilus influenzae type B (Hib)

1. Diptheria: Vaccinations against the bacterium that causes diphtheria were first introduced into the Irish vaccination schedule in the 1930s, as part of a 2-in-1 vaccine against diphtheria and tetanus. The modern 6-in-1 vaccine has been available in Ireland since 2008, and contains diphtheria toxoid.

Diphtheria is still a serious disease and cause of death (mainly affecting unimmunised children) in some countries -in the year 2000, 30,000 people were diagnosed with diphtheria and 3000 people died of the disease worldwide. However, in Ireland the number of cases of diphtheria declined rapidly after the introduction of a vaccine, and there have been no reported cases of diphtheria in Ireland since 1967. The elimination of diphtheria in Ireland is thought to be due to 'herd' or community immunity whereby a high rate of vaccination in the population prevents outbreaks of disease.

More than 15,000 people died from diphtheria in the USA in 1921, before a vaccine was available. There has been one reported case of diphtheria in the USA since 2004. Unfortunately the disease hasn't been eradicated, even though the number of cases has decreased since vaccines became available (the number of cases of diphtheria has reduced dramatically from nearly 100,000 in 1980 to just under 5,000 in 2013 worldwide) - therefore vaccination is the only way to protect ourselves and those around us.

2. Tetanus: Children have been routinely vaccinated against tetanus in Ireland for over 50 years. Because the bacterium (Clostridium tetani) that causes the condition lives outside the body in soil, manure and other similar substances, tetanus cannot be completely eradicated. Therefore, vaccinations will always be required to protect us against this severe condition, which is often fatal if not treated quickly.

Although once a common condition, it is now quite rare and usually affects people over 50 years of age who did not receive the vaccination in childhood. Neonatal tetanus, a condition usually caused by infection of the umbilical cord at birth, resulting in the baby developing tetanus, is a problem in some parts of the developing world (though the numbers are thankfully decreasing), but has not been reported in Ireland for over 30 years. Only 12 cases of tetanus have been reported in Ireland since 1981, and although cases worldwide have decreased from an estimated 114,000 in 1980 to 13,528 in 2013, it is still a problem in countries where a vaccine is not available.

The modern 6-in-1 vaccine has been available in Ireland since 2008, and contains tetanus toxoid. Five doses of the vaccine are required to give full immunity to the bacterium - therefore in Ireland, babies receive three doses of the 6-in-1 vaccine at 2, 4 and 6 months, and then have two boosters of a tetanus vaccine when they are in school.

3. Whooping cough (Pertussis): The serious condition whooping cough (also called pertussis) is caused by the Bordetella pertussis bacterium and can last for several weeks. Whooping cough is most common in babies under 5 months old and unfortunately is very contagious and can be fatal (half of all babies with whooping cough will need to be admitted to hospital, and about 1 in 500 babies with the disease will die from it). Because it is so serious and often develops in babies too young to have received all of their vaccinations, it is very important that the rest of the population are vaccinated so that infants aren't exposed to infected people.

Vaccinations against whooping cough were introduced into Ireland in 1952, and the number of cases of whooping cough reduced very quickly from approximately 5,000 per year to 100-200 annual cases in the mid-1990s. However there have been some outbreaks of the disease in recent years, with the number of reported cases increasing from 2010 onwards. Most of these cases of the disease are in babies who are too young to have received the vaccinations, and in 2011 and 2012 three babies under two months old died from whooping cough. Worldwide, pertussis infections are still a big problem and there were over 161,000 cases in 2013, though this is still a dramatic reduction from the nearly 2 million cases in 1980.

Babies in Ireland receive the 6-in-1 vaccine at 2, 4 and 6 months, followed by two boosters of pertussis vaccines when they are at school. The 6-in-1 vaccine contains purified antigens of the Bordetella pertussis bacterium (subunit vaccine).

4. Hepatitis B: The Hepatitis B virus causes this condition which can result in permanent liver damage. Hepatitis B is very hard to treat, particularly in children who often develop a chronic condition, so vaccination to prevent the infection is the best way to control the disease. The hepatitis B virus can be transmitted by infected people in bodily fluids, and can be passed from an infected mother to her newborn baby during childbirth (often people do not realise they are infected).

Hepatitis B affects more than 350 million people worldwide, but there are few reported cases in Ireland (infection is quite high in certain high risk groups). In 1992 the World Health Organisation recommended that vaccination against hepatitis B should be included in childhood immunisation programmes, and it was introduced into Ireland in 2008 as part of the 6-in-1 vaccine. The 6-in-1 vaccine contains recombinant hepatitis B virus antigens (subunit vaccine).

5. Polio: Polio is caused by the three types of the very infectious poliovirus, and is usually transmitted in the faeces of infected people. Therefore, poor sanitation can lead to outbreaks of the disease. The poliovirus often enters the central nervous system and can cause paralysis - often permanent - and was a terrifying infection for children and parents before a vaccine was made available.

Vaccination against polio was introduced into Ireland in 1957, and originally children routinely received a live attenuated vaccine - you may remember being given this vaccine on a sugar cube. The 6-in-1 vaccine contains inactivated poliovirus. Children in Ireland receive the 6-in-1 vaccine at 2, 4 and 6 months and then a booster of the polio vaccine when they are 4-5 years old.

Worldwide, polio cases have reduced from over 52,000 in 1980 to less than 500 in 2013, and polio has been eradicated in nearly every country, though there are always risks of new outbreaks if the numbers of vaccinations drop. In 1956, the year before polio vaccines were available in Ireland, there were approximately 500 cases of polio reported - this was dramatically reduced to only a handful of cases by the early 1960s, and the last reported case in Ireland was in 1984.

6. Haemophilus influenzae type B (Hib): The 6-in-1 vaccine provides protection against the very contagious Haemophilus influenzae type B bacterium. Hib can cause very serious illness, including meningitis and blood poisoning (septicaemia), especially in children and young babies. Hib infections have reduced in Ireland since the introduction of a vaccine in 1992 (from about 100 per year in the 1980s' to 10 in 2002), though a few cases continue to be reported. The Hib vaccine has been given to over 20 million people worldwide, with no serious adverse reactions (medical conditions that may or may not be caused by the vaccine) and is considered to be extremely safe.

Babies in Ireland receive four doses of Hib vaccines - three doses of the 6-in-1 vaccine at 2, 4 and 6 months, and a booster Hib vaccine at 13 months. The 6-in-1 vaccine contains a conjugate vaccine for Hib.

Most common side effects are mild and temporary. They are a result of the child's immune system responding to the vaccination, and making antibodies that will protect the child in the future. Most side effects will ease after a day or two and any discomfort can be treated with over-the-counter medicines such as paracetamol or ibuprofen (ask your pharmacist for medicine appropriate for your child's age).

Before getting the vaccination, speak to your doctor if your child has been sick or 'off form' over the past few days. Illness can reduce the effectiveness of a vaccine. The nurse or doctor administering the vaccine will check your child's temperature first, to see if they may have any other infections or illnesses.

Common side effects of INFANRIX hexa that are usually no cause for concern: tiredness, loss of appetite, high temperature (over 38oC), swelling/pain/redness at injection site, unusual crying (baby is 'off form'), irritability or restlessness.

Other quite common side effects (seen in up to 1 in 100 children receiving INFANRIX hexa) include diarrhoea, vomiting, high temperature over 39.5oC, and swelling larger than 5 cm or hard lump where the injection was given.

Remember that the benefits of receiving vaccines that protect your child from serious diseases hugely outweigh any mild side effects from vaccination.

Rarer side effects include: sleepiness, coughing, swelling of the injected limb, rash, swollen glands in the neck, armpit or groin (lymphadenopathy), in babies born very prematurely (at or before 28 weeks of gestation) longer gaps than normal between breaths may occur for 2-3 days after vaccination, temporarily stopping breathing (apnoea), swelling of the face, lips, mouth, tongue or throat which may cause difficulty in swallowing or breathing (angioedema), swelling of the whole injected limb, blisters where the injection was given, itching (dermatitis). These side effects are rare and have been reported in very few children.

If you are concerned about your child, contact your doctor or local hospital for advice.

Allergies to substances within vaccines can occur, though they are very rare (they happen in fewer than 1 in 10,000 people receiving the vaccine). An allergic reaction to a vaccine would happen quickly - probably before you left the GP's surgery. Signs of an allergic reaction may include itchy skin, rash, shortness of breath and swelling of the face or tongue.

Before getting the vaccination, speak to your doctor if your child has experienced any allergic reactions previously.

If you are concerned about your child, contact your doctor or local hospital for advice.

Vaccines are tested exhaustively before they are provided to the public (it normally takes 10-15 years to develop a new vaccine). INFANRIX hexa (6-in-1 vaccine produced by GlaxoSmithKline) was licenced for use in Europe in 2000 and introduced into the childhood vaccination schedule in Ireland in 2008.

Clinical trials were carried out initially on over 1,000 children to collect data on possible side effects, such as those listed above, and the vaccine is now included in the routine vaccination schedule in several countries, including Ireland, Australia and New Zealand, and has been administered to thousands of children.

Worldwide, approximately 112 million children received vaccines against diphtheria, tetanus, pertussis and polio in 2013 - that's 84% of all children. The World Health Organisation estimates that 2-3 million deaths are prevented each year by vaccines.