diphtheria, pertussis and tetanus vaccination

Last edited 04/2019

Diphtheria, pertussis and tetanus was the original triple vaccine used in the childhood immunisation schedule in the UK at 2,3 and 4 months of age. The vaccine became a quadruple vaccine with the addition of Haemophilus influenzae type B (HiB) and now has five components with addition of inactivated polio vaccine (in the UK, the use or oral polio vaccine has been replaced by use of inactivated polio vaccine (1)):

  • combined vaccine - diphtheria, tetanus, acelular pertussis, inactivated polio, haemophilus inflenzae type B and Hepatitis B (DTaP/IPV/Hib/Hep B)
    • administered at two, three and four months old as part of the childhood immunisation schedule

  • combined vaccine - diphtheria, tetanus, acelular pertussis, inactivated polio vaccine (dTaP/IPV)
    • administered as part of the pre-school booster

  • diphtheria, tetanus and inactivated polio vaccine (Td/IPV)
    • recommended for boosting teenagers aged 13 to 18 years old
    • can also be used for primary immunisation in unvaccinated individuals aged 10 years and over
    • in consideration of travel vaccination - where tetanus, diphtheria or polio protection is required and the final dose of the relevant antigen was received more than ten years ago, Td/IPV should be given (2)

Check uptodate details in the The Green Book before prescribing/administering a vaccine.

Check the Summary of Product Characteristics (SPC) before prescribing/administering a vaccine.


  • Td/IPV vaccine should be used where protection is required against tetanus, or diphtheria or polio in order to provide comprehensive long-term protection against all three diseases (2)
  • Tetanus/diphtheria (Td) vaccine may still be available but is not recommended because it does not give protection against poliomyelitis (2)
  • booster doses of vaccines containing acellular pertussis are associated with an increased risk of injection site reactions, compared to primary vaccination (3)
    • some of these affect the entire limb, and may involve blistering around the site of swelling. Such reactions usually develop within 24 hours of vaccination and recover without sequelae within ~5 days
      • risk appears to be dependent on the number of prior doses of DTaP vaccine, with a greater risk following the 4th and 5th doses, although such reactions to a DTaP booster may also occur in children who have been primed with one or more doses of a DTwP vaccine
      • such reactions do not contraindicate further doses of DT or DTaP vaccine
      • if a child presents with signs of extensive limb swelling following d/DTaP-IPV pre-school vaccination it is important to carefully consider whether this may be a recognised injection site reaction. In the absence of clinical or laboratory signs of infection, antibiotics may be ineffective and unnecessary


  1. Department of Health (August 10th 2004). New vaccinations for the childhood immunisation programme. PL/CMO/2004/3, PL/CNO/2004/2, PL/CPHO/2004/3.
  2. Department of Health (August 2004). Poliomyelitis - Green Book Update.
  3. Current Problems in Pharmacovigilance (2006);31:1-12.
  4. https://www.nhs.uk/conditions/vaccinations/6-in-1-infant-vaccine/ (Accessed 26/4/19)