Pre-school Booster

Expand All

The pre-school booster vaccine used in the UK boosts protection against four serious diseases: diphtheria, tetanus, whooping cough (pertussis), and polio. Before vaccines existed, these diseases used to kill thousands of children in the UK every year, as the table at the bottom of the page shows.

It is given at 3 years and 4 months, and can safely be given at the same time as other vaccines in the UK routine schedule. It is a combination vaccine, which reduces the number of injections a child needs.

The pre-school booster vaccines used in the UK do not contain any live bacteria or viruses. They cannot cause any of the diseases they protect against.

Two brands of pre-school booster vaccine are used in the UK: Repevax (see the patient information leaflet ) and Infanrix IPV (see the patient information leaflet ). A third vaccine, Boostrix-IPV, is only used for pertussis vaccination in pregnancy.


In the UK the pre-school booster is given at around 3 years and 4 months to children who received the initial doses of the vaccines in the first year of life (see the 5-in-1 vaccine for children born on or before 31st July 2017, and the 6-in-1 vaccine for children born on or after 1st August 2017).


Very common, affecting more than 1 in 10 people at each dose:

  • pain, redness and swelling at the injection site
  • temperature of 38°C or higher
  • feeling irritable or restless
  • tiredness or feeling sleepy
  • loss of appetite
  • unusual crying
  • headache

Common, affecting up to 1 in 10 people at each dose:

  • feeling sick or being sick (nausea or vomiting)
  • diarrhoea
  • temperature of 39.5°C or higher
  • hard lump at the injection site
  • itching or skin inflammation in the area where the vaccine was injected
  • generally feeling unwell or weak
  • aching or swollen joints

Many of these symptoms can be relieved by giving paracetamol (Calpol) if your child is over 2 months, or ibuprofen if your child is over 3 months and weighs more than 5kg. See the NHS Website for more advice on giving painkillers to babies and children).

Very rare (affecting fewer than 1 in 10,000 people at each dose):

  • high temperatures, sometimes leading to fits (also called convulsions or febrile seizures)
  • unusual high-pitched screaming and hypotonic-hyporesponsive episodes (HHE), during which the child may become blue, pale and/or limp

You should consult your doctor if your child experiences fits or HHE episodes after vaccination. This is mainly to check that it is the vaccine causing the symptoms, and not some unrelated disease. Symptoms such as fits can be very worrying for parents, but there is no evidence of long-term effects. Children can normally safely receive vaccines in the future. For more information on febrile seizures generally, see the NHS Website.  

As with any vaccine, medicine or food, there is a very small chance of a severe allergic reaction (anaphylaxis). Anaphylaxis is different from less severe allergic reactions because it causes life-threatening breathing and/or circulation problems. It is always extremely serious but can be treated with adrenaline. Healthcare workers who give vaccines know how to do this.

In the UK between 1997 and 2003 there were a total of 130 reports of anaphylaxis following ALL immunisations, although no deaths as a result of the reaction were reported.  Around 117 million doses of vaccines were given in the UK during this period. This means that the overall rate of anaphylaxis is around 1 in 900,000.

If you are concerned about any reactions that occur after vaccination, consult your doctor. In the UK you can report suspected vaccine side effects to the Medicines and Healthcare products Regulatory Agency (MHRA) through the Yellow Card Scheme.

You can also contact the MHRA to ask for data on Yellow Card reports for individual vaccines. See more information on the Yellow Card scheme and monitoring of vaccine safety.


The pre-school booster vaccines used in the UK for children are called Repevax and Infanrix IPV. Apart from the active ingredients (the antigens), they contain very small amounts of these ingredients:

  • Aluminium, which strengthens and lengthens the immune response to the vaccine
  • Polysorbate, used as an emulsifier to hold other ingredients together (Repevax only)
  • A very small amount of phenol, used as a preservative (Repevax only)
  • Medium 199 (containing amino acids, mineral salts and vitamins), used as a stabiliser (Infanrix IPV only)
  • Sodium chloride (salt) (Infanrix IPV only)

Pre-school booster vaccines may also contain traces of these products used during the manufacturing process:

Growing the active ingredients for the vaccine:

  • The polio part of the pre-school booster is grown in the laboratory using animal cell strains.

Other brands of pre-school booster vaccines or 4-in-1 vaccines used in other countries may contain different ingredients. If you are not in the UK, ask for the patient information leaflet for the vaccine you are offered.


Can the pre-school boosters cause disease?

The pre-school booster vaccine used in the UK is sometimes referred to as DTaP/IPV, which stands for ‘Diphtheria, Tetanus, acellular Pertussis and Inactivated Polio Vaccine’.

The vaccine includes the acellular pertussis vaccine (the ‘aP’ in ‘DTaP’). This uses only those parts of the pertussis (whooping cough) bacteria needed to produce an immune response. This greatly reduces the chance of serious side effects such as high temperatures, screaming episodes, and HHE (see section on 'Side effects' above). The whole cell (wP) vaccine used in the UK until 2004 contained many more antigens and had a greater risk of side effects.

The vaccine also includes inactivated polio virus (IPV). As this is inactivated, it cannot cause polio (which was a very small risk with the live, oral polio vaccine used in the UK until 2004).

How well does the vaccine work?

The table below shows the average number of deaths in the UK each year, before and after introduction of a vaccine:

Disease Before After
Diphtheria 3500 0
Tetanus 200 0
Pertussis 1000 3
Polio 200 0
TOTAL 4900 3

Source: Public Health England


Page last updated Friday, January 21, 2022