6-in-1 Vaccine

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The 6-in-1 vaccine is given to babies in the UK during their first year of life to protect against six serious diseases:

Before vaccines existed, these diseases killed thousands of children in the UK each year. Both brands of the 6-in-1 vaccine offered in the UK (Infanrix hexa and Vaxelis) have a good safety record and provide excellent protection against all six diseases.

The 6-in-1 vaccine replaced the 5-in-1 vaccine in the UK in late 2017, when the hepatitis B vaccine was added.  All babies born on, or after 1 August 2017 in the UK, are now given the 6-in-1.  Babies need three doses of the vaccine to get the full benefits. The 6-in-1 can be given safely at the same time as other vaccines. You can see the full UK routine schedule for details of the other vaccines given to babies.

It is a combination vaccine, meaning that just one injection is needed to protect against multiple diseases. It does not affect a baby's immune system negatively and reduces the total number of injections a baby needs. You can read more about combination vaccines and multiple vaccinations and why these are not a risk to a baby's immune system.

The 6-in-1 vaccines used in the UK do not contain any live bacteria or viruses, and cannot cause any of the diseases they protect against.

In the UK the 6-in-1 vaccine is given to babies in three doses when they are 8, 12 and 16 weeks old. The repeated doses are needed to give a good immune response.

Almost all babies can receive the 6-in-1 vaccine. But there are some cases in which a baby should not have the vaccine:

  • if they have a fever at the time of vaccination
  • if they have signs of a neurological problem that is getting worse, including poorly controlled epilepsy
  • if they are allergic to the vaccine or any of its ingredients (see section on 'Ingredients' for details)

Ask your GP, nurse or health visitor for advice if your child has a history of fits (febrile seizures) or has suffered a fit within 72 hours of a previous dose of the 6-in-1 vaccine.

There are special recommendations for babies born to mothers who are infected with hepatitis B. Please see 'More information' below.


All vaccines go through rigorous testing and regulatory processes that can take up to 15 years to ensure they are safe and effective. Like all medicines, vaccines can cause side effects, but not everyone gets them.

After each dose of the 6-in-1 vaccination, a baby may experience some side-effects. Depending on how many infants experience these side-effects, they are classed as very common, or common, or rare, or very rare. 

Very common - more than 1 in 10 may experience these following each dose:

  • redness, pain and/or swelling at the injection site. This is more common at the second and third dose.
  • raised temperature (fever). This is more common at the second and third dose.
  • irritability
  • loss of appetite
  • vomiting
  • abnormal crying

Many of these symptoms can be relieved by giving paracetamol (Calpol) if your child is over two months, or ibuprofen (Nurofen) if your child is over three months and weighs more than 5kg. For advice on giving painkillers to babies and children, please see NHS Choices.

Common - may affect up to 1 in 10 infants at each dose:

  • diarrhoea
  • bruising or bleeding at the injection site
  • a small, painless lump at the injection site. This usually disappears and is not serious.

Rare - affecting up to 1 in 1000 infants at each dose:

  • unusual high-pitched screaming

Very rare - affecting fewer than 1 in 10,000 infants at each dose:

  • fits (also called febrile convulsions or febrile seizures)

Episodes during which the infant may become blue, pale and/or limp, known as hypotonic-hyporesponsive episodes (HHE) used to be a rare side-effect of the type of pertussis vaccine - a whole cell vaccine - that was used in the UK until 2004. 

Since 2004 a different type of pertussis vaccine, with just three or five components, has been included as part of the 6-in-1 and 5-in-1 vaccines. As a result, HHE is now very, very rare and its precise frequency is unknown.

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 NHS Choices.

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. 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.


There are two brands of the 6-in-1 vaccine used in the UK. The original vaccine, called Infanrix hexa, along with Vaxelis, which was introduced from 2022.  Apart from the active ingredients (antigens) that produce the immune response for diphtheria, tetanus, whooping cough/pertussis, polio, Hib and hepatitis B, these vaccines contain water and very small amounts of other added ingredients. Many of these are already found naturally in the body or food. These 6-in-1 vaccines do not contain porcine gelatine. 

Added ingredients include, but are not limited to:

  • aluminium, which strengthens and lengthens the immune response to the vaccine
  • lactose and Medium 199 (containing amino acids, mineral salts and vitamins), both used as stabilisers
  • sodium chloride (table salt) and sodium phosphate (found naturally in some foods) 

The final vaccine may also contain traces of these products that are used during the manufacturing process:

  • formaldehyde, an organic compound used to inactivate (kill) the viruses used in the vaccine
  • yeast proteins from the yeast used to grow the hepatitis B proteins for the vaccine. A tiny quantity may remain in the vaccine, but there is no evidence that this can cause allergic reactions.
  • antibiotics (neomycin, polymyxin and streptomycin), used to stop bacteria growing and contaminating the vaccine during manufacture. People who know they are allergic to these particular antibiotics, should seek specialist advice. Antibiotics which most commonly cause allergic reactions are not used.

Some of the active ingredients for these vaccines are grown in a laboratory. This includes:

Other brands of the 6-in-1 vaccine used in non-UK countries may contain different ingredients. If you want to find out more about the specific ingredients of the vaccine you are offered, ask for the specific patient information leaflet.

You can also read more about vaccine ingredients here.


Why the 6-in-1 was introduced?

Introducing the 6-in-1 vaccine into the UK was part of a global strategy to eliminate the hepatitis B virus worldwide.  Hepatitis B infection can result in serious liver problems, including scarring and cancer and can be fatal. As the disease is so serious, the World Health Organization has said that all babies should be vaccinated against it. 

The 6-in-1 vaccines in use in the UK are not new. Infanrix hexa was licensed in Europe in 2000 and since then over 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. 

Vaxelis was licensed in 2016. The UK Health Security Agency considers Infanrix hexa or Vaxelis interchangeable, although it recommends that the same brand is given for all three doses, if possible. A key difference is how they are supplied. Vaxelis is supplied in a pre-filled syringe, while Infanrix hexa needs mixing. 

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 for pertussis was introduced in the UK in 1990, and has led to a drop in the number of cases.

Components of the 6-in-1

The 6-in-1 vaccine is sometimes referred to as DTaP/Hib/HepB/IPV, which stands for ‘Diphtheria, Tetanus, acellular Pertussis, Hib, Hepatitis B and Inactivated Polio Vaccine’.

'Acellular' means that the pertussis vaccine (the aP in DTaP) does not contain any whole pertussis bacteria. It contains just three proteins from the surface of the pertussis bacteria.

These produce a good immune response by themselves. This greatly reduces the chance of serious side effects, such as high temperatures, screaming episodes, and hypotonic-hyporesponsive episodes (HHE). See section above for more on possible side-effects.

The 6-in-1 vaccine also includes inactivated polio virus (IPV). This means the virus has been killed (inactivated) and cannot cause polio. This was a very small risk with the live, oral polio vaccine (OPV) used in the UK until 2004.

The Hib part of the 6-in-1 is known as a conjugate 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. See our page on 'Types of vaccine' for more information on conjugate vaccines.

The brand names of the 6-in-1 vaccines used in the UK are Infanrix hexa and Vaxelis. These vaccines contain far fewer components that make the immune system produce antibodies to protect people against the disease. This means the vaccines are less likely to cause side effects. Please see the patient information leaflets for more information. Infantrix hexa and Vaxelis patient information leaflets.

How well does the vaccine work?

Before the introduction of vaccines, thousands of babies and children in the UK died from these diseases annually. This dropped to almost no deaths following the introduction of vaccination. Evidence shows that the 6-in-1 vaccine is very effective.

Diphtheria: A study carried on a large-scale diphtheria outbreak in Russia in the 1990s showed that three doses of diphtheria-containing vaccine were 97% effective against diphtheria.

Pertussis (whooping cough): Studies have shown that the acellular pertussis vaccine in the 6-in-1 has 80-95% effectiveness, but it is thought that protection may wane relatively quickly. This is an area of ongoing research, for example through the 'Periscope' project in which Oxford Vaccine Group is a partner.

Hib disease: Original studies done in the UK in the early 1990s showed that 90 to 99% of children developed protective levels of antibodies following three doses of Hib vaccine.

Polio: Studies carried out during polio epidemics show that the inactivated polio vaccine in the 6-in-1 is over 90% effective against paralytic polio.

Tetanus: Five doses of tetanus vaccine at the recommended intervals (three doses of the 6-in-1, plus the Pre-school booster and the Teenage booster) give up to 100% protection against tetanus. However, protection can wane over time. A tetanus booster may be recommended for adults who have an injury and are not sure about their tetanus vaccination history. 

People who travel to counties where tetanus may be more of a risk than in the UK may also be recommended a booster. 

Hepatitis B: The World Health Organization states that the hepatitis B vaccine is 95% effective in preventing infection and the development of chronic disease and liver cancer due to hepatitis B. Protection lasts at least 20 years and is probably lifelong.

Hepatitis B vaccination for babies born to mothers who have hepatitis B infection or are at high risk

Babies born to mothers who are infected with hepatitis B are at high risk of becoming infected 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. 

There is a special hepatitis B screening programme in place in the UK for pregnant women and an immunisation programme for babies who are identified as being at risk.  When the 6-in-1 vaccine was introduced, the immunisation programme changed slightly. 

Most babies born to mothers with hepatitis B infection will receive a total of six vaccines to protect against hepatitis B between birth and 12 months of age. Three of these vaccines are given as part of the routine 6-in-1 schedule at 8, 12 and 16 weeks of age. Additional individual hepatitis B vaccines (called monovalent) are also given straight after the baby is born, again at 4 weeks old and at 12 months old.

If a baby is born to a hepatitis B negative woman but known to be going home to a household with another hepatitis B infected person and at immediate risk of infection, a single dose of a monovalent hepatitis B vaccine should be offered before the baby is discharged from hospital. The baby should then continue on the routine childhood schedule that starts at 8 weeks.

Babies who are born to women with high levels of infection may also given an injection of hepatitis B immunoglobulin at birth. This provides immediate, temporary protection while the baby develops immunity through the other hepatitis B vaccines. Specific hepatitis B immunoglobulin (HBIG) is made from the plasma of people who have been immunised against hepatitis B and screened for other blood-borne infections, including HIV and hepatitis C.

At one year of age, when a baby has had all the vaccines, they will be tested to make sure they are not infected with hepatitis B.


Last Updated Monday, March 13, 2023