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Vaccine against diphtheria, tetanus, whooping cough, poliomyelitis, Hib infection and hepatitis B

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Diphtheria

Diphtheria is a nose and throat infection caused by diphtheria bacteria. The bacteria release toxins that can cause swelling in the throat so it becomes difficult to breathe. The toxins can also attack the heart, kidney and nervous tissue and impair their function. The disease can be fatal. During and just after the Second World War, there were diphtheria epidemics in Norway. After vaccination was introduced in 1952, only a few cases of the disease have occurred after infection abroad. Diphtheria continues to occur in parts of Europe and other parts of the world.

Tetanus

Tetanus is caused by a bacterium that can be found in soil. Infection can occur when the bacterium comes into contact with wounds. The disease is not transmitted from person to person. The bacteria release toxins that attack the nervous system and cause muscle stiffness and painful cramps. The disease is highly fatal. It is rarer in the Nordic countries than in warmer regions.

Whooping cough (Pertussis)

Whooping cough is a prolonged (6–12 weeks) airway infection with severe fits of coughing. Whooping cough can cause brain damage due to lack of oxygen during coughing fits, and in rare cases, death. It can be particularly dangerous for infants. In older children and adults, the disease can be prolonged and bothersome, but is rarely life-threatening. The disease is extremely contagious – nearly 100 % of the population had the disease before we began to vaccinate. 

Poliomyelitis

Poliomyelitis is a viral disease that usually results in cold-like symptoms, body aches or diarrhoea. It can cause inflammation of the brain membrane (meningitis) and attack nerve cells, leading to permanent paralysis. Fatalities do occur. Before vaccination began in 1957, there were annual polio epidemics in Norway in which several hundred children and adolescents were permanently paralysed. Up to 10 % died. After vaccination was introduced, the disease has been under control in Norway and several other countries. Europe was declared free of polio in 2002, but the disease still occurs in several countries in Africa and Asia. Unvaccinated people can become infected while travelling and can infect other unvaccinated people on their return.

Hib infection

The bacterium Haemophilus influenzae type b (Hib) was the most frequent cause of inflammation of the brain membrane (meningitis) in children under 5 in Norway before the vaccine became available. Hib can also cause other serious infections such as pneumonia, arthritis and epiglottitis. After vaccination was introduced in 1952, Hib infections are almost non-existent in Norway. 

Hepatitis B

Hepatitis B is an inflammation of the liver caused by the hepatitis B virus. The virus is found in blood and body fluids. It cannot penetrate intact skin. Infection occurs through mucous membranes or broken skin, such as the injection site of a bloody syringe, a blood transfusion or sexual contact. Babies born to mothers infected with the disease are at risk of infection.

Among infected infants, over 90 per cent will have a chronic infection and become carriers of hepatitis B virus if they do not receive preventive care. The risk of becoming a chronic carrier decreases throughout childhood and is less than 5 per cent for those infected in adulthood. Throughout life, people with Down’s syndrome have a high risk of becoming chronic carriers because of impairments in their immune systems.

A chronic carrier state can lead to cirrhosis or cancer of the liver. Chronic carriers are also the main source of infection for hepatitis B so it is important to limit the number of new carriers as much as possible.

Children born to mothers who are carriers will follow a separate vaccination programme that starts within 24 hours after birth. Mothers who know that they are carriers should inform their midwife or public health nurse. 

Six-component vaccine against diphtheria, tetanus, whooping cough, poliomyelitis and Hib infection

The vaccines against diphtheria and tetanus are based on toxins produced by the bacteria but without their toxic effect. The whooping cough vaccine contains purified fragments of the whooping cough bacterium. The polio vaccine contains three types of killed polio virus that can cause disease in humans. The Hib vaccine contains fragments of the bacteria's sugar capsule (polysaccharide) bonded to proteins. None of the vaccine components are live. The hepatitis B vaccine contains fragments of the hepatitis B virus. After three doses of vaccine, children develop lasting protection against Hib infection and hepatitis B. 

Common side-effects

Restlessness, irritability, crying, malaise, drowsiness, loss of appetite or feeling unwell for 1-2 days after vaccination occur in less than 1 in 10 children. It is not always clear if these symptoms are due to the vaccine or other causes.

Redness, swelling and tenderness around the injection site also occur in less than 1 in 10 children and may last for several days. Major, painful reactions are rare. A brief fever may affect more than 1 in 10 children during the first few days after vaccination. Fewer than 1 in 100 children have a fever over 39.5˚C. In such cases, seek medical attention because the fever may have another cause that needs treatment.  

The vaccine used is called Hexyon.