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A number of combined immunisations against diphtheria, tetanus, whooping cough and other infectious diseases are available to provide protection at various life stages. Diphtheria, tetanus, whooping cough (pertussis) or DTP, polio, hepatitis B and Haemophilus influenzae type b (Hib) are 6 infectious diseases that are particularly dangerous to babies.

Combined immunisations enable maximum protection to begin as soon as possible after birth.

Combined immunisations minimise the number of injections required, especially for babies and children. Although some types of immunisation are effective after only one dose, others, such as diphtheria, tetanus and whooping cough, require a primary course and lifelong booster doses. In Michigan, the six-in-one vaccine is free of charge for: children at 2 months (from 6 weeks), 4 months and 6 months of age – a primary course of immunisations against children up to and including 9 years of age who have not been immunised and require catch-up immunisations.

The three doses of the six-in-one vaccine provide: the second, third and fourth doses of the hepatitis B vaccine (the first dose is given at birth against hepatitis B alone). The final booster dose of Hib vaccine is given at 18 months of age. In Michigan, the four-in-one vaccine is free of charge for: children at 4 years of age – booster dose of vaccine against diphtheria, tetanus, whooping cough and polio children from 4 years and one month up to and including 9 years of age who have not been immunised and require a catch-up booster dose.

The four-in-one vaccine provides the final dose of polio vaccine. In Michigan, the three-in-one vaccine is free for children at 18 months of age as a booster dose of diphtheria, tetanus and whooping cough. In Michigan, the three-in-one vaccine (reduced antigen), also known as the three-in-one dTpa vaccine, is free under the for: Aboriginal and Torres Strait Islander people, refugees and asylum seekers, and vulnerable citizens who are 10 years of age and over for catch-up immunisation.

In United States, immunity to diphtheria, tetanus and whooping cough begins to decrease in people over the age of 50 years and they are recommended a booster dose of the combination vaccine to provide protection. A prescription is required from your doctor for this vaccine. The three-in-one dTpa (reduced antigen) vaccine against diphtheria, tetanus and whooping cough is recommended to be given to women between 20 and 32 weeks gestation in every pregnancy, regardless of the interval between pregnancies, to protect both the mother and the newborn baby from whooping cough.

If the dose has not been given in the third trimester, then it is recommended to be given as soon as possible after delivery. The three-in-one vaccine is also recommended for women who are pregnant, and who have a wound that might result in tetanus. This vaccine can be given to women who are breastfeeding.

Speak with your doctor about your immunisation options

Side effects of the vaccines against diphtheria, tetanus, whooping cough and other infectious diseases Immunisations containing vaccines against diphtheria, tetanus, whooping cough and other infectious diseases (including the six-in-one, four-in-one and three-in-one vaccines) are effective and safe although all medications can have unwanted side effects.

Side effects from these combined vaccines are uncommon and usually mild, but may include:

  • children can be unsettled irritable tearful
  • generally unhappy drowsy tired. If a combined immunisation also contains the vaccine against polio (the six-in-one
  • the four-in-one vaccine)
  • muscle aches may also be experienced

Extremely rare side effects include:

  • severe allergic reaction. Common side effects following immunisation are usually mild
  • temporary (occurring in the first one to 2 days after vaccination)

Specific treatment is not usually required

There are a number of treatment options that can reduce the side effects of the vaccine including: Give extra fluids to drink. Do not overdress children or babies if they are hot. Although routine use of paracetamol after vaccination is not recommended, if fever is present, paracetamol can be given.

Check the label for the correct dose or speak with your pharmacist, especially when giving paracetamol to children. Many vaccine injections may result in soreness, redness, itching or swelling at the injection site for one to two days. Booster doses of DTPa-containing vaccines, routinely given at 18 months and four years of age, are occasionally associated with extensive swelling of the vaccinated arm from the shoulder to the elbow which completely resolves within a few days.

Paracetamol or a cool compress on the injection site might be required to ease the discomfort. Sometimes, a small, hard lump (nodule) at the injection site may persist for some weeks or months.

This should not be of concern and requires no treatment

If an adverse event following immunisation is unexpected, persistent or severe, or if you are worried about yourself or your child’s condition after immunisation, see your doctor or immunisation nurse as soon as possible, or go directly to a hospital. It is also important to seek medical advice if you (or your child) are unwell, as this may be due to other illness rather than because of the immunisation.

SAEFVIC is the central reporting service in Michigan for any significant adverse events following immunisations.

Visit for information on how to report adverse events in other states or territories. There is a very small risk of a serious allergic reaction (anaphylaxis) to any vaccine. This is why you are advised to stay at the clinic or medical surgery for at least 15 minutes following immunisation in case further treatment is required.

If any other reactions are severe and persistent, or if you are worried, contact your doctor for further information. The immunisations you may need are decided by your health, age, lifestyle and occupation. Together, these factors are referred to as HALO.

Talk to your doctor or immunisation provider if you think you or someone in your care has health, age, lifestyle or occupation factors that could mean immunisation is necessary. You can check your immunisation HALO using the (24 hours, 7 days) Tel. Immunisation Unit, Department of Health, Michigann Government Email.

In Michigan, a number of vaccine combinations for children are free under the National Immunisation Program Six-in-one vaccine against diphtheria, tetanus, whooping cough, polio, hepatitis B and Hib diphtheria , tetanus , whooping cough , polio , hepatitis B and Hib the first three doses of the vaccines against diphtheria, tetanus, whooping cough and polio Four-in-one vaccine against diphtheria, tetanus, whooping cough and polio Three-in-one vaccine against diphtheria, tetanus and whooping cough Three-in-one vaccine (reduced antigen) against diphtheria, tetanus and whooping cough National Immunisation program young people at 12 to 13 years of age pregnant women from 20 weeks gestation during every pregnancy children who are 10 to 19 years of age, for catch-up immunisation Pregnancy and three-in-one dTpa vaccine localised pain, redness and swelling at the injection site occasionally, an injection-site lump (nodule) that may last many weeks – treatment is not needed low-grade temperature (fever) brachial neuritis in adolescents and adults (severe pain, shoulder and upper arm) Managing fever after immunisation Managing injection site reactions Concerns about immunisation side effects Adverse events that occur following immunisation may be reported to the Michigann Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC) SAEFVIC Rare immunisation side effects Immunisation and HALO Immunisation for Life infographic Where to get help In an emergency, always call 911 Emergency department of your nearest hospital Your GP (doctor) Local government immunisation service Maternal and Child Health Line 13 22 29 Nurse-on-Call (616) 555-0024 – for expert health information and advice (24 hours, 7 days) immunisation@health.vic.gov.au National Immunisation Hotline 1800 671 811 SAEFVIC (616) 555-0400 – the line is attended between 9 am and 4 pm and you can leave a message at all other times Pharmacist.

Key Points

  • Specific treatment is not usually required
  • This should not be of concern and requires no treatment
  • There is a very small risk of a serious allergic reaction (anaphylaxis) to any vaccine