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4 in 1

The 4-in-1 vaccine protects against four serious infectious diseases:   

  • Diphtheria   
  • Tetanus   
  • Pertussis (Whooping Cough)   
  • Polio  

The vaccine is given to your child because these diseases can cause severe illness, permanent disability, or death, particularly during infancy and early childhood.   

It boosts the immunity gained from the earlier infant 6-in-1 vaccination programme.

The 4-in-1 vaccine used in the UK is supplied as:  

Both vaccines provide protection against the same four diseases.

In Wales, babies are routinely offered the vaccine at 3 years and 4 months old 

The vaccine is given as an injection in your child’s thigh muscle. The vaccine can also be given in your child’s upper arm 

The booster is timed shortly before children begin school because as children grow the initial protection naturally decreases over time. The booster at 3 years and 4 months strengthens immune memory and provides longer-lasting protection throughout early childhood, especially as children begin mixing more with others in nurseries and social settings. 

 

Diphtheria  

What is diphtheria?  

Diphtheria is a serious bacterial infection. 

The bacteria infect the nose and throat and produce a powerful toxin that damages cells throughout the body. It can quickly lead to breathing problems and may damage the heart and nerves. In severe cases, it may cause death 
 
Before the diphtheria vaccine was introduced to the UK, there were up to 70,000 cases of diphtheria and up to 5,000 deaths a year.   

By vaccinating our children, diphtheria is rare in the UK, but cases continue to occur worldwide.  
 
How does diphtheria spread?  

Diphtheria spreads through:  

  • Coughing  
  • Sneezing  
  • Respiratory droplets  
  • Close contact with an infected person  
  • Contact with contaminated objects  

The infection spreads rapidly where vaccination rates are low.  
 
Symptoms may include:  

  • Sore throat  
  • Fever  
  • Swollen neck glands   
  • Difficulty swallowing  
  • Difficulty breathing  

A thick grey membrane (pseudomembrane) developing in the throat, which may block the airway  
 
Complications  

  • Serious complications include:  
  • Airway obstruction  
  • Suffocation  
  • Heart inflammation (myocarditis)  
  • Heart failure  
  • Nerve damage  
  • Paralysis  
  • Death   

 
Tetanus  

What is tetanus?  
 
Tetanus is a disease that affects the body’s nerves, causing muscle spasms and breathing problems. It is a severe disease that can lead to serious health problems if not treated quickly 

The bacteria is common in our environment and found in soil, dust and animal manure. 

It can enter the body through a wound, cut, burn, animal bites, or scratches. Tetanus cannot spread from person to person.  
 
Symptoms  

  • Stiffness in your jaw muscles (lockjaw), which can make it difficult to open your mouth  
  • Painful muscle spasms, which can make it difficult to breathe and swallow  
  • A high temperature  
  • Sweating  
  • A rapid heartbeat  
  • Symptoms can be severe and extremely painful.  

 
Complications  

  • Respiratory failure  
  • Fractures caused by severe muscle spasms  
  • Intensive care admission  
  • Death  

 Even with modern medical treatment, tetanus remains a serious condition.  
  

Pertussis (Whooping Cough)  

What is whooping cough?  

Pertussis, more commonly known as whooping cough, is an infection that affects the lungs and airways. Whooping cough is very infectious, which means it passes easily from one person to another 

Although older children and adults often recover, it is particularly dangerous for young babies, especially before they have completed their vaccination. Which is why whooping cough vaccinations are given in pregnancy as well.  
 
How does whooping cough spread?  
 
The infection spreads through respiratory droplets released when infected people:  

  • Cough  
  • Sneeze  
  • Have close contact with others  
  • Symptoms  
  • Early symptoms resemble a common cold:  
  • Runny nose  
  • Mild fever  
  • Sore throat  

After one to two weeks, severe coughing attacks develop.  

Symptoms may include:  
 

  • Repeated coughing fits  
  • Vomiting after coughing  
  • Difficulty breathing  
  • Characteristic "whoop" when breathing in  

Young babies may not cough but instead stop breathing temporarily (apnoea).  
 
Complications  
Complications include:  

  • Pneumonia  
  • Seizures  
  • Brain injury  
  • Cerebral hypoxia from prolonged coughing  
  • Hospital admission  
  • Death  

Babies younger than six months are at greatest risk.  
 
 

Polio   

What is polio?  
Polio is a virus that can affect your nerves. It can cause permanent muscle weakness, usually in the legs. If polio affects the chest muscles or the brain, it can lead to very serious health problems. 

Before the polio vaccine was introduced, there were as many as 8,000 cases of polio in the UK. Thanks to the polio vaccination’s ongoing success, the UK hasn’t seen a natural polio infection in over 40 years. The last case was reported in 1984. This is why it is important to vaccinate to stop diseases such as polio from coming back 
 
How does polio spread?  

  • Contact with infected poo 
  • Contaminated food  
  • Contaminated water  
  • Close personal contact or from coughs or sneezes 

Symptoms  

Many infected people have no symptoms.  
Those who become ill may develop:  

  • a high temperature
  • extreme tiredness (fatigue)  
  • headaches  
  • being sick (vomiting)  
  • a stiff neck, and   
  • muscle pain

Rarely, polio can lead to more serious symptoms that affect the brain and nerves, such as weakness in your muscles (paralysis), usually in the legs.  

Complications  
Polio can cause: 

  • Permanent paralysis  
  • Irreversible muscle weakness  
  • Breathing difficulties  
  • Respiratory failure  
  • Death  
  • Paralysis caused by polio is irreversible.  

 
Can my child have the vaccine if they have a cold? 

A minor illness does not usually require postponement. 

Vaccination can normally continue if the child has: 

  • Runny nose 
  • Mild cough 
  • Mild cold symptoms 
  • Mild tummy upset 
  • Vaccination may be delayed if the child has: 
  • High temperature 
  • Acute severe illness 

 

Can children with egg allergy receive REPEVAX? 

Yes. REPEVAX does not contain egg protein. 

Relevant components to consider include possible trace manufacturing substances such as: 

  • Neomycin 
  • Polymyxin 
  • Streptomycin 
  • Formaldehyde 

 
Are there any other reasons why the vaccine should not be given?
Very few children cannot have the 4-in-1 vaccination. The vaccine should not be given to children who have had a severe (life-threatening) allergic reaction to:

  • any ingredient in the vaccine, or
  • a previous dose of the vaccine.

Speak to your GP, practice nurse or health visitor before your child has the vaccination if your child:

  • has a bleeding disorder (such as haemophilia, where their blood does not clot properly), or
  • has ever had a seizure (fit) that wasn’t caused by a fever.

What happens at the appointment?
The practice nurse or GP will explain about the vaccinations and answer your questions. With babies, the vaccine is given by injection in the thigh. In children over the age of 12 months, injections are usually given in the upper arm.

Write down any questions you have and ask the health professional at the vaccination appointment.