Six-fold vaccination: which vaccinations does it contain?

What is the sixfold vaccination?

The Standing Vaccination Committee (STIKO) of the Robert Koch Institute provides an updated vaccination calendar every year . In the first two years of your baby’s life, vaccinations against ten different infectious diseases are currently recommended. Since many of these vaccinations are divided into several partial vaccinations, it is possible to combine individual vaccinations into multiple vaccinations in order to keep the number of injections low. The most common of these combination vaccinations is currently the six-fold vaccination, which is intended to protect your child against the pathogens of six different diseases:

• tetanus
• diphtheria
• whooping cough
• HiB
• polio
• Hepatitis B

What is the benefit of the sixfold vaccination?

Tetanus : The tetanus vaccine protects your child from the bacterium Clostridium tetani, which is the causative agent of the disease. It is mainly found in soil, for example in the garden, or in dust and can get into the human body through open wounds. Due to the consistent vaccination coverage since the early 1980s, only 10 to 20 cases of tetanus are known in Germany each year.

Diphtheria : This respiratory infection, against which the six-fold vaccine is designed to protect, is caused by Corynebacterium diphtheriae. The bacterium can secrete toxins that not only affect the respiratory tract, but can also lead to heart muscle inflammation. In Germany and Western Europe, diphtheria only occurs very rarely, but in Eastern Europe, which is relatively close by, the contagious infectious disease is still widespread, which is why rapid re-spreading is possible with a decreasing vaccination rate.

Whooping Cough : The bacterium Bordetella pertussis is responsible for this highly contagious infectious disease that can cause inflammation of the lungs or brain or stop breathing. Before the vaccine was introduced in Germany, around 80,000 people fell ill with whooping cough every year, of which around 4,000 had to be hospitalized for treatment due to the severe course of the disease. After the vaccine was introduced in the early 1990s, the number of hospital stays required fell to around 1,000 within ten years.

Polio : Also known as polio, this infectious disease is caused by a virus. In rare cases with a severe course of the disease, this can lead to the typical symptoms of paralysis and permanent physical damage. Polio is as good as extinct in our latitudes. However, with long-distance travel to Africa and Asia, where the virus is still widespread, it can easily return to Western Europe. A high vaccination rate, for example in the form of six vaccinations, is therefore still important in Germany.

HiB : The germ Haemophilus influenzae B causes inflammation of the nasopharynx and middle ear or pneumonia, especially in children, since the still immature immune system is unable to recognize and fight off the pathogen poorly. Before the vaccine was introduced, the HiB germ was also responsible for a large proportion of meningitis in small children. Some strains of the germ are also resistant to antibiotics, which is why prevention through the six-fold vaccination is the safest protection against an acute illness.

Hepatitis B : Hepatitis B is one of the most common viral infectious diseases worldwide. It can be transmitted through contact with the blood or body fluids of infected people and leads to liver inflammation, which becomes chronic in an average of five to ten percent of cases. Newborns are particularly affected by this chronification, which is alarming because chronic disease at a young age increases the likelihood of dying from serious liver damage many times over.

When and how to give the sixfold vaccination?

The recommended vaccination schedule of the STIKO stipulates that infants should be vaccinated six times from the age of two months, so that they can already receive a basic immunization before the loss of nest protection and the gradual onset of infections.

Recommended times for the individual partial vaccinations:

• 1st vaccination: From the 3rd month of life
• 2nd vaccination: From the 4th month of life
• 3rd vaccination: From the 5th month of life
• 4th vaccination: Between the 12th and 14th month of life

There should be a gap of at least four weeks between the first three vaccinations and at least six months between the third and fourth vaccination. Even longer breaks between the individual vaccinations are possible and unproblematic. The vaccinations already carried out do not lose their effectiveness due to the incompleteness of the recommended immunization steps.

Survey: Vaccination rate for six vaccinations

In our MomaSquad survey, we asked 550 mothers whether they had their child vaccinated according to the STIKO recommendations with the six-fold vaccine. 75 percent of mothers have their child vaccinated at the recommended time in the first few months of life. About 10 percent of mothers opt for a pure triple vaccination against polio, diphtheria and tetanus instead of the sixfold vaccination. An unexpectedly high 15 percent do not have their children vaccinated against these pathogens, or only do so at a later age.

Source: MomaSquad survey of 550 mothers (2011)

booster vaccinations

Individual vaccinations of the six-fold vaccination should be refreshed again at a later date. These include:

• According to STIKO, vaccinations against tetanus, diphtheria and whooping cough should be boosted once between the ages of 6 and 7, and again between the ages of 10 and 18. From the age of 19, a booster is recommended every ten years after the last vaccination. The antigens against tetanus, diphtheria and whooping cough are usually offered as a triple vaccine.
• For the vaccination against polio, the STIKO recommends a booster between the ages of 10 and 18.
• If no basic immunization against hepatitis B has been carried out by the age of 10, it is strongly recommended that the vaccination be made up for at this point in time.

Of course, the six-fold vaccination is not a must. You can also decide to have individual vaccinations carried out later or even to do without them altogether. With some vaccinations, a so-called monovalent vaccine, which is only effective against the causative agent of a single disease, allows the second partial vaccination to be omitted. The vaccinated person therefore only gets a total of three doses of the corresponding vaccine. However, not every antigen is available as a single vaccine, such as the HiB antigen or the whooping cough vaccine.

Who shouldn’t get the 6-fold vaccine?

Vaccinations certainly make sense to protect your child from certain serious diseases. However, under certain circumstances you should, at least temporarily, refrain from having your child vaccinated or take certain precautions:

• If your child has already had a severe vaccination reaction after a vaccination that went beyond the usual vaccination reactions, your child should not be treated again with the same serum. Symptoms that indicate an excessive reaction include severe shortness of breath, fainting, seizures, or a very high, persistent fever.
• In the case of acute infections that require treatment, you should refrain from vaccination. In such a case, vaccination should be carried out no earlier than two weeks after recovery. On the other hand, banal infections, such as a simple cold, usually do not pose a problem. But it is best to talk to your doctor again in this case.
• If you have a known allergy to one of the vaccines in the sixfold vaccine, you should choose an alternative vaccine, if available. An allergy to chicken protein can also be problematic with some vaccines, since vaccine viruses used to be cultured on chicken eggs and some vaccines can therefore still contain chicken protein components.

It is very important that you have a detailed consultation with the doctor treating you before you get vaccinated, in which you can talk to him about any possible risk factors and in which he can show you alternative options for vaccines, if any.

Possible side effects of the sixfold vaccination

In general, the standardized six-fold vaccination is considered to be well tolerated. However, as with many other vaccinations, slight side effects such as redness, swelling or temporary pain at the injection site are common side effects. A slight fever, nausea or fatigue can also occur as a result of vaccination. However, since different active ingredients are combined in the multiple vaccination, it is difficult to say which component exactly causes a reaction.

High-pitched screaming and crying in infants lasting several hours has been reported in association with vaccination. This phenomenon is most likely related to the whooping cough antigen, but a direct connection has not yet been confirmed.

The vaccines against hepatitis B and diphtheria are suspected to interfere with the production of the blood platelets that help blood to clot, which can lead to temporary problems with blood clotting.

After vaccination with the polio active substance, the neighboring lymph nodes may swell and react painfully to pressure.