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Immunisation - Infanrix-hexa

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Infanrix-hexa

  • Combined diphtheria-tetanus-acellular pertussis, hepatitis B, enhanced inactivated polio vaccine and Haemophilus influenzae type b vaccine.
  • Provides protection against 6 diseases in a single vaccine

Interval between doses

  • Recommended 6 weeks
  • Minimum of 4 weeks

Efficiency following 3 doses in infancy

  • DTap and IPV components - 85-98% efficacy up to 4 years of age against Pertussis.
  • Hepatitis B component - 98.5-100% infants develop protective antibody titres.
  • hib component - 96-100% develop (Hib) anti PRP titres ≥ 0.15mcg/ml.
  • One month after receipt of the three dose primary vaccination series with aP-IPV the overall seropositivity for polio virus serotypes 1 2, 3 was 99.5%.6

Diphtheria/ Tetanus/ Pertussis

Diptheria

  • Diphtheria is an acute bacterial infection of the throat which may result in obstructed breathing. It can also infect the skin.
  • The bacterium may produce a toxin which can affect the nervous system - causing paralysis; and the heart - causing heart failure. One out of every 10 people who suffer diphtheria die from it, even when antibiotics are used.

Tetanus

  • Tetanus (sometimes called lockjaw) is a serious illness caused when tetanus bacteria grow in a wound which has broken the skin. It causes muscle rigidity and painful spasms, leading to an inability to breathe, and death.
  • Even with modern intensive care tetanus mortality is about 10 percent overall, and much higher in older people.
  • Wounds which are deep and dirty are those most likely to allow tetanus bacteria to grow. Good wound cleaning is the most important first aid measure but, as tetanus may follow even minor injuries, immunisation is the only certain protection.
  • As tetanus is not passed on from person to person, no protection is afforded by others in the community being immunised. Individual protection against tetanus is the only protection as most people suffer wounds from time to time.

Pertussis

  • Pertussis, also known as whooping cough, is a highly infectious illness affecting the trachea and lungs. It causes coughing spasms accompanied by difficult breathing and at times vomiting. The classic whoop is uncommon in infants. Pertussis usually lasts about three months.
  • It can occur at any age but is at its most serious in the very young. Half of those affected under six months of age, need be hospitalised.
  • Pertussis mortality rates are highest in the first few months of life. Young age, lack of immunisation, low socio-economic status and premature delivery are associated with an increased risk of fatal pertussis. Deaths occur despite hospital admission and intensive care.
  • Adults may have whooping cough and present as having a persistent cough without realising it may be pertussis, which they could easily pass on to baby.
  • Pertussis can also cause long term damage to the lungs. Because of the breathing difficulty leading to lack of oxygen, brain damage can occur.
  • The risk of catching pertussis in New Zealand is still considerable because too few of our children are given the vaccine. Epidemics occur every four years and during these years the risk of catching the disease is much greater.
  • Immunity from the natural disease or the vaccine may not be lifelong. Older people who catch the infection may not be very ill but they can pass on the disease to babies who have not been immunised and who may become very ill - making immunising babies at the correct times very important.
  • NB: Babies need all the doses to be fully vaccinated (not just ones given in hospital).

Polio - Inactivated Polio Vaccine (IPV) - Information

  • Oral poliomyelitis vaccine was discontinued in New Zealand from February 2002.
  • IPV contains three strains of polio virus (the Mahoney, MEFI and Saukett strains) inactivated by formaldehyde. The viruses are highly purified and grown in cultures of Vero cell line.
  • Infanrix-hexa is the schedule vaccine for infants and children.
  • Poliomyelitis is the acute illness following infection of the gastrointestinal tract with one of the three types of polio virus. The virus is highly neurotropic and its primary effect occurs in the neurones of the spinal anterior horn or the motor ganglia of the brain stem, leading to paralysis.

Haemophilus Influenzae Type B (Hib)

  • Haemophilus Influenzae Type B bacterium is a gram negative coccobacillus
  • Hib causes meningitis, pneumonia, epiglottitis, septic, arthritis, bacteraemia, cellulitis and empyema in infants and young children. Mortality rate is 5% despite antibiotics and medical care. Survivors of Hib meningitis may have a 30-40% risk of long term neurological development impairment
  • The Hib component is not the same as was given in Comvax (Hib PRP-OMP), rather the Hib (PRP-T) as given in Hiberix. The Hib PRP-OMP (in Comvax) is more immunogenic after the 1st dose than the Hib PRP-T (in Infanrix-hexa). Hib PRP-T (in Infanrix-hexa) has a low response after the 1st dose however there is an immune response after the 2nd dose, and a marked response after the 3rd. Therefore timeliness of the first doses is important to reduce the risk of cases less than 6 months of age4.

Storage of Vaccine

See Cold Chain Management

Administration

Parental consent

  • Ensure parent has had the Immunisation Choices pamphlet to read.
  • Parent countersigns and also prints last name underneath signature on "once only" page of medication chart indicating consent after discussion with Dr/NS-ANP.

Administered to baby when

  • Infanrix-hexa and Prevenar 13 given at 6 weeks of age regardless of baby's weight. (The very young are at the greatest risk from pertussis and Hib). See Contraindications and Special Precautions and adverse reactions.
  • Baby must be nursed on apnoea mattress for 24 hours after vaccine given and vaccine given at least 24 hours prior to discharge.

Giving vaccine

Click here for details of drawing up, giving and documentation of vaccine.

References

  1. Infanrix®-hexa Data Sheet - Medsafe
  2. Aristegui J, Dal-Re R, Diez-Delgado J, Mares J, Casanovas JM, Garcia-Corbeira P, et al. Comparison of the reactogenicity and immunogenicity of a combined diptheria, tetanus, acellular Pertussis, hepatitis B, inactivated polio (DTPa-HBV-IPV) vaccine, mixed with the Haemophilus influenzae type b (Hib) conjugate vaccine and administered as a single injection, with the DTPa-IPV/Hib and hepatitis B vaccines administered in two simultaneous injections to infants at 2, 4 and 6 months of age.Vaccine 2003; 21(25-26): 3593-600
  3. Avdicova M, Prikazsky V, Hudeckova H, Scherman LWP. Immunogenicity and reactogenicity of a novel hexavalent DTPa-HBV-IPV/Hib vaccine compared to separate concomitant injections of DTPa-IPV/Hib and HBV vaccines, when administered according to a 3, 5, and 11 month vaccination schedule. European Journal of Pediatrics 2002; 161:581-587
  4. Decker MD, Edwards KM, Bradley R, Palmer P. Comparative trial in infants of four conjugate Haemophilus influenzae type b vaccines. Journal of Pediatrics 1992; 120 (2 Pt 1): 184-9.
  5. 2008 National Immunisation Schedule: Health Provider Hand booklet. Ministry of Health: Wellington
  6. Immunisation Handbook, 2006. Ministry of Health: Wellington

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Document Control

  • Date last published: 01 September 2015
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Author(s): Newborn Services Clinical Practice Committee
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years