Painful versus painless vaccines – Article on different DPT combination vaccines

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Author: Gauri Kshirsagar

DPT vaccines

DPT vaccines

The combination of diphtheria, tetanus, and pertussis (DPT) vaccines into a single product has been central to the protection of the pediatric population over the past 50 years. The addition of inactivated polioHaemophilus influenzae, and hepatitis B vaccines into the combination has facilitated the introduction of these vaccines into recommended immunization schedules by reducing the number of injections required and has therefore increased immunization compliance.

What is the advantage of combination vaccines?

  1. Fewer Injections
  2. Reduced trauma to the infant
  3. Higher rate of compliance with complex vaccine schedules
  4. Better vaccine coverage
  5. Timely vaccination – vaccine schedule completed on time
  6. Reduced administration cost
  7. Lower storage space requirement
  8. Allows incorporation of newer vaccines in the schedule

What different types of combinations with DPT which are available in the market?

The commercial vaccines available vary in combinations related to their contents and also differ in costs and side effects.

Combination vaccines are available for

  • DPT + Hepatitis B (quadrivalent vaccine)
  • DPT + Hepatitis B + Hib vaccine (pentavalent vaccine) e.g.Easy-five® or Pentavac®
  • DPT + Hib vaccine + IPV (pentavalent vaccine) e.g.Pentaxim®

What are painless and painful vaccines?

Previously the vaccines at 6, 10 and 14 weeks were each given separately, in which the DPT vaccine was a very painful one. The pain used to last for 24 hours, associated with fever and irritability. DPT vaccine, is now available in “whole cell” and “acellular forms” i.e pertaining to the type of Pertusis agent used (either DPT or DPaT). The acellular vaccine has fewer side effects. Some forums, mention these two different vaccines as “painful” or “painless”. The difference is that, the acellular vaccine will have less pain and lesser side effects like fever or irritability than the cellular one (but it will pain while administering the injection). DPT(painful) combination vaccine is available in the market as Easy-five® or Pentavac®, while DTaP (painless) combination vaccine is called as Pentaxim®.

What is the difference between Easy-five® or Pentavac® AND Pentaxim®

When you go to the health center to get your baby vaccinated, you will be given an option to choose between Easy-five® (Pentavac®) OR  Pentaxim® vaccine. Easy-five®  and Pentaxim®  both give protection against 5 diseases.  Let us see how the two differ:

Easy-five® or Pentavac®          Pentaxim®
Vaccine contains DTP Vaccine contains DTaP
DTP stands for:

1.      Diptheria,

2.     Tetanus

3.     Pertusis

Easy-five® covers:

1.      Diptheria,

2.     Pertussis (cellular component), ,

3.      Tetanus

4.      Haemophilus Influenza type B

5.      Hepatitis B.

DTaP stands for

1.      Diptheria,

2.      Tetanus

3.      Acellular Pertusis

Pentaxim® covers:

1.      Diptheria,

2.      Pertusis (Acellular Component) ,

3.      Tetanus,

4.      Haemophilus influenza type B

5.      IPV (injectable polio vaccine).

Protection offered is similar, but DTP has side-effects like fever and irritability DTaP does not have these side-effects.
DTP is less expensive.

Easy-five® costs about Rs. 950/- and  Pentavac® costs about Rs. 500/-

DTaP is more expensive.

Pentaxim® costs about Rs. 2250/-

Does the immunization schedule change on the choice of vaccine depending on if its a painless or painful vaccine?

YES!!!!

It is upto you to decide which vaccine to administer depending on all these factors. If you go for Easy-five®, baby should be given injectable polio vaccine, while in case of Pentaxim® hepatitis-B vaccine must administered separately.

The Schedule of the vaccines will change according to brand of vaccine preferred. I personally preferred Pentaxim® vaccine because of easy availability, easy compliance, lesser post vaccination side effects like fever, irritability etc and there is no confusion regarding the Hepatitis B vaccine schedule. Following is an example of how the schedule will vary according to the type of vaccine:

Easy-five® or Pentavac® Pentaxim®
Birth 1.     BCG

2.     OPV – Zero Dose

3.     Hep B Vaccine – I

1.      BCG

2.      OPV – Zero Dose

3.      Hep B Vaccine – I

1 Month Hepatitis B – 2
6 Weeks 1.     Pentavac -1

2.     IPV -1

3.     Rotavirus – 1

4.     PCV-1 (Can be given now or after 1 week)

1.     Pentaxim-1

2.     Rotavirus- 1

3.     PCV-1 (Can be given now or after 1 week)

10 Weeks 1.     Pentavac – 2

2.     IPV -2

3.     Rotavirus – 2

4.     PCV-1 (Can be given now or after 1 week)

1.     Pentaxim -2

2.     Rotavirus- 2

3.     PCV-2 (Can be given now or after 1 week)

14 Weeks 1.     Pentavac -3

2.     IPV -3

3.     Rotavirus – 3

4.     PCV-3 (Can be given now or after 1 week)

1.     Pentaxim -2

2.     Rotavirus- 2

3.     PCV-2 (Can be given now or after 1 week)

6 Months —– Hepatitis B – 3

 

Are there any recent studies that show painful vaccine is better than a painless one?

Yes, there is a recent comparative study (done in 2013) show slight increase in the efficacy of cellular vaccine compared to that acellular vaccine.  Please do refer to my blog post: Comparing effectiveness of two types of pertussis vaccines (Cellular and Acellular DPT/DTP Vaccine) for detailed information regarding the same.

 

 

To know about the cost of vaccine in India do read my post: Detailed cost of vaccination/ Immunization in India (Birth to 10 years of age)


*Thanks a lot for visiting my blog. Please do ‘★ LIKE’ the post if you found it to be useful.Your comments, suggestions, criticism and all opinions are very much appreciated. Please do write your queries in the Reply/comments section and I will try to get back to you asap.


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53 thoughts on “Painful versus painless vaccines – Article on different DPT combination vaccines

  1. Dear Gauri, really a very informative article.
    My little one is due for 10th week vaccination.
    Following is our record:
    @Birth : BCG, OPV1 and Hep-B1 (Revac-B)
    @6th week: Pentavac + OPV2 + Rotarix + Prevenar 13
    @10week: As per your advice : Pentavac + OPV2 + Rotarix + Prevenar 13
    Additionally IPV1 (which is missed in 6th week).
    Pentavac has Hep-B but as per general vaccine schedule Heb-B is not mentioned in 10week. (Please note we had taken Hep-B1 @Birth and @6th week). Please give your valuable feedback.
    Regard,
    Anukrishnan

    Like

  2. Sir after birth of baby he has immunised by painful vaccination upto 6month but now we want painless vaccination then it’s ok or we should follow painful vaccination what is good for our baby pls suggest us

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  3. hi gauri,

    ur really awesome the tips u gave here are fabulous . i have given all the vaccination in Government health center
    so what is ur view about it . when compared to the private doctors vaccination list? i belong to Chennai actually i am about to put 18 th month vaccination fr my son in next week that is DTP B1
    IPV B1 Hib B1.kindly suggest..

    Like

    • Hi,Thanks for the positive input. It is not bad at all to vaccinate your child at a government hospital. Moreover you may get vaccines at a reasonable cost, though some vaccines which do not come under the immunization schedule may be charged or may be unavailable, do take a not of that. Also brands available will be standardised and costly/painless vaccines will not be available. Having said that if you have given all the vaccines at the government set up I suggest you continue the booster doses there itself.

      Like

  4. Hi can you tell me about hexaxim vaccination ? And I have also read that painless vaccination are not good for babies future health is this true?

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    • Hexaxim(®) (DTaP-IPV-Hep B-Hib) is a new, thiomersal-free, fully liquid, hexavalent combination pediatric vaccine containing diphtheria and tetanus toxoids, acellular pertussis, inactivated poliovirus, recombinant hepatitis B virus surface antigen and Haemophilus influenzae type b polysaccharide (polyribosylribitol phosphate) conjugated to tetanus toxoid.

      Do refer to authentic studies carried out before choosing a vaccine. A “comment” or “experience” doesn’t count in deciding if a vaccine is good or bad.

      Like

  5. Hi Gauri,
    Thanks fir the detailed infirmation.
    After checking so many reviews i have found that normal vacination is better than painless. My 6week son git his first painless vacination.
    So now can i go with normal vacination and for first vacination do i need to require any booster and when?

    Like

    • Hi,

      Hope you are referring to authentic comparative studies of celluar versus acelluar vaccines and not hearsay reviews, in which case there is only one study published in 2013 that shows the efficacy of painful vaccines ‘slightly’ better than painless vaccines.Overall the efficacy of both vaccines is comparable, not to forget the chance of side effects and distress caused in cellular(painful) vaccines to the baby. There is no such term called as ‘normal’ vaccine. You can shift between the brands, but preferably stick to one brand throughout. No doubt the cost variation is huge, hence do read the whole immunization schedule thoroughly and make a decision. Good Luck!

      Like

  6. Yes, preferable you should stick to the same brand. But still it’s ok, sometimes in cases of unavailability of the required brand, doctors switch to others, since all vaccines have to be given on a schedule.

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  7. Sir/mam, my baby was given paunfull vaccine first time and later doctors wife (she also doctor) has given painless vacccine. When I asked her, she told there will be no problem. Because brand is different , Medicine is same. Is it correct?

    Like

      • Thanks a lot mam… And third time again went for paunfull vaccine . Now my fear is, because of 2nd dose (painles vaccine -pentaxim) my baby anti bodies can recognise , when virus attacked. Why I’m asking this, some other doctors said….whatever we give first time the same only has to be continued…..plz advice mam….

        Like

  8. Hello Ma’m,

    I have 1 query plz help me out in that.

    Query: My Pediatrics Gave PENTAVAC™ SD on 6th and 10th month to my Baby. As per my knowledge and your blog Pentavac is combination of DPT + Hepatitis B + Hib vaccine.

    So now i want to know that, OPV & IPV are added in PENTAVAC™ SD or i have to demand my Pediatrics to gave OPV & IPV to my Baby?

    Like

    • Hi,
      Pentavac SD contains “Diphtheria, Tetanus, Pertussis (Whole Cell),
      Hepatitis B (rDNA) and
      Haemophilus Type b
      Conjugate Vaccine (Adsorbed) I.P.”. Hence additionally injectable polio vaccine (IPV) and oral rotavirus has to be given to the baby at 6, 10 and 14 weeks on the same day or after a week or so of pentavac.

      Regards,
      Gauri

      Like

  9. I have two vaccination dpt injection in India.but last one injection is saudi Arabia.last week injected.any problem in the baby health.

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  10. Hello mam. my baby is six months.I have two dpt the pentvac injection in India.but am staying in Saudi Arabia the last one injection is infanrix hexa.any problem mam.give me suggestion please.

    Like

  11. Hi, Gauri,

    Now a days its hard to find a reasonable Pediatrician, could you please suggest me one nearby Pimpri Chinchwad area.

    Also let me know if the below mentioned vaccines as suggested by my current Dr are necessary. Also comment on price point of view:

    PCV-1, Prevenar 13 (Rs 4000 per dose x 3 = Rs 12000/- + Rs 3800 booster )
    Rotaviral vaccination Rotateg (Rs 1200 per dose x 3 = Rs 3600/-)

    Regards
    Mr Vaibhav

    Like

    • Hi, Vibhav

      You can check out Justdial or Practo for good Pediatricians (with references and ratings) in Pimpri -Chinchwad, since personally I don’t know anyone in that area.
      The price of the above vaccines mentioned by you is the average cost in Pune.
      In my opinion all vaccines recommended by IAP should be given, there is nothing more important than the health of a baby (buy less toys if necessary 🙂 ). Still if cost is the constrain, then I suggest you complete the Rotavirus vaccination atleast.

      Regards,
      Gauri

      Like

  12. Realy nice information most confusion arise from government schedule and IAP schedule for vaccination both r different which one is better?

    Like

    • Universal Immunization Programme (UIP) is a vaccination program launched by the Government of India in 1985. The program now consists of the following:
      1. BCG (Tuberculosis)
      2. DPT (diphtheria, pertussis (whooping cough), tetanus)
      3. OPV (poliomyelitis)
      4. Measles
      5. Hepatitis B
      6. Japanese Encephalitis (In high risk cases)
      7. TT (in pregnant and booster doses for kids)
      In 2014 it was announced that more vaccines will be added to the program, namely rotavirus, rubella and injectable polio vaccineFrom February 2017, Union ministry of health and family welfare will roll out Measles-Rubella vaccine from UIP. Hence UIP consists of most important vaccines which are provided free of cost at health centres.
      Whereas IAP also recommends Pneumococcal 13-valent Conjugate Vaccine (PCV) , chicken pox vaccine and MMR instead of Measles at 9 months.
      Private practitioners also recommend Flu vaccines (optional) and also there is an option of Painless vaccines.

      Like

  13. My doc said painless are less effective so we gave pentavac 1 and pentavac 2 now my daughter due for 3rd dose. Can I go for painless this time cos I can’t see her crying for a day

    Like

  14. Pingback: Comparing effectiveness of two types of pertussis vaccines (Cellular and Acellular DPT/DTP Vaccine) | Raising Twins

  15. Thanks for your detailed explanation about vaccines. Now, I have a 3 months old daughter. The first DTP vaccine was given by a pediatrist on my daughter’s buttocks. He said that the ones giving vaccine on thighs are useless. Then 2nd vaccine was given by another doctor. He gave vaccine on her right thigh and when inquired, he said that the vaccine given on buttocks are useless. Kindly enlighten me about this.
    Thanks

    Liked by 1 person

  16. Thanks a lot for the detailed article.so much of confusion and doubtfulness while I was taken my LO to the clinic for vaccination.now solved everything.

    Like

  17. Thanks for your detailed and in depth coverage!! Also amazed to know that you have twin daughters and you are sharing your experience. It was really helpful for us!!

    Like

      • Hi Gauri, really a very informative
        Post all my doubts about painless and painful vaccines are clear now thank u very much!
        With this detail have decided to go for painful one however my daughter’s first vaccine is painless so is that fine if I choose painful one from now onwards I.e. 10th week vaccine.
        Please help me here.
        Also not sure if iam correct in the beginning you have mentioned DTPs available in d market as short list ,in that pentaxim and pentavac combinations are in contradict with the details explained below, have a look not sure though.

        Like

      • Hi Sindhu,
        Thank you for your kind words.
        1) As you have already vaccinated your child using pentaxim, changing to Pentavac may change her vaccine schedule, hence you can discuss this with her pediatrician. As far as I know, you can give her three painless vaccine with one booster dose of painful vaccine (Some pediatricians recommend this)
        2) And yes there was typing error as you mentioned, which I have now corrected. Thanks for noticing.

        Regards,
        Gauri

        Like

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