In 2017 the UK decided to replace the 5-in-1 vaccine with a 6-in-1 vaccine. The 5-in-1 vaccine protected against diphtheria, tetanus, whooping cough (pertussis), polio and Hib disease (Haemophilus influenzae type b). The 6-in-1 vaccine also gives protection against hepatitis B, a cause of serious liver disease which can be fatal. The 6-in-1 vaccine was introduced for all UK babies born on or after 1st August 2017. Babies born before 1st August 2017 received the 5-in-1 vaccine which is no longer routinely used in the UK.
The 6-in-1 vaccine is not new. It was licensed in Europe in 2000, and since then about 150 million doses have been given in 97 countries in Europe and across the world, including Canada, Australia and New Zealand. The vaccine used in the UK is licensed for children from 6 weeks to 10 years old.
Since hepatitis B is so serious, the World Health Organization has said that all babies in the world should be protected by hepatitis B vaccination. Introducing the 6-in-1 vaccine into the UK is part of a global strategy to eliminate the virus worldwide. See the Public Health England statementfor more information.
The 6-in-1 vaccine used in the UK is sometimes referred to as DTaP/Hib/HepB/IPV, which stands for ‘Diphtheria, Tetanus, acellular Pertussis, Hib, Hepatitis B and Inactivated Polio Vaccine’.
The 6-in-1 vaccine includes the acellular pertussis vaccine (the 'aP' in 'DTaP'). 'Acellular' means that it does not contain any whole pertussis bacteria. It contains just three proteins from the surface of the pertussis bacteria, which produce a good immune response by themselves. This greatly reduces the chance of serious side effects such as high temperatures, screaming episodes, and HHE (see the section on side effects above). The whole cell (wP) vaccine used in the UK until 2004 contained whole killed pertussis bacteria. These contained thousands of antigens (the proteins and sugars that stimulate the immune system) and had a greater risk of side effects.
The 6-in-1 vaccine also includes inactivated polio virus (IPV). As this is inactivated (killed), it cannot cause polio (which was a very small risk with the live, oral polio vaccine used in the UK until 2004).
The Hib part of the 6-in-1 is a conjugate vaccine (see our page on 'Types of vaccine'). Sugars (polysaccharides) are taken from the capsule around the Hib bacteria and joined to a non-toxic protein from tetanus. The protein helps to stimulate the immune system in a broader way to respond well to the vaccine. This gives a better immune response in individuals of all ages.
Different countries have decided on different schedules for the 6-in-1 vaccine. In the UK, the three doses are given as close together as possible to give babies early protection from pertussis (whooping cough). This disease can be particularly severe in very young babies, so the earlier they are protected the better. This 'accelerated' programme was introduced in the UK in 1990, and led to a drop in the number of pertussis cases.
The immunisation rate in the UK for three doses of the 5-in-1 vaccine has been around 94% since 2001, just below the World Health Organization target of 95%. However, rates have been lower than 94% in some areas of the UK. For example, in London in 2014 the coverage rate was around 90%, and in some parts of London the rate was below 75%.
Hepatitis B vaccination for babies born to mothers who have hepatitis B infection
Babies born to mothers who are infected with hepatitis B are at high risk of becoming infected themselves during birth. Infection in this way leads to long-term chronic infection in 90% of cases, and puts the child at risk of serious liver disease later in life. Since 1998 the UK has had a hepatitis B screening programme for pregnant women, and an immunisation programme for babies who are identified as being at risk.
This programme is continuing, but it has changed slightly as a result of the introduction of the 6-in-1 vaccine. Babies born to mothers with hepatitis B infection will still receive two doses of the individual (monovalent) hepatitis B vaccine, one immediately after birth and one at 4 weeks of age. Babies born to women who are thought to be particularly infectious may also be given hepatitis B immunoglobulin at birth. This provides immediate, temporary protection while the baby develops their own immunity through vaccination. Babies in this group will then follow the routine schedule and receive three doses of the 6-in-1 vaccine at 8. 12 and 16 weeks of age. At one year of age they will receive another dose of the individual hepatitis B vaccine, and they will also be tested to make sure they are not infected with hepatitis B.