Author: Gauri Kshirsagar
*DISCLAIMER: Please note I have mentioned routinely used vaccine brands in INDIA as examples. Please do check the ingredients and discuss in detail with your paediatrician before making a decision. We DO NOT promote any brands. This article is only for information and discussion, NOT an advice column.
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 polio, Haemophilus 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?
- Fewer Injections
- Reduced trauma to the infant
- Higher rate of compliance with complex vaccine schedules
- Better vaccine coverage
- Timely vaccination – vaccine schedule completed on time
- Reduced administration cost
- Lower storage space requirement
- 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 SD/PFS® | 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 PentavacSD/PFS® 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 SD/PFS® | 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.
Details about the brand names used in this article:
PENTAVAC SD/PFS:
PENTAXIM
EASY FIVE:
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.
Raising Twins™ 
Hi mam
My baby first took easysix vaccine at one hospital but next one we went to government hospital they said there is hexaxim vaccine only available and we took it any problem in that pls help
Regards
PRADEEP
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Hexaxim is a painless vaccine no doubt, and there is no issue if you have given one easy six vaccine before that.
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Dear Mam,
i need you opinion. Doctor has given Hexaxim vaccine for my baby on 6th week. Now we are about to go for 10th week vaccine. We are planning to have vaccine in government hsopital. Please let me know is there any problem will occur when we shift from hexaxim vaccine to vaccine provided in the Government hospital.
Regards,
Kumar
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Hi, There is no problem on shifting to other vaccines. Only thing, you will have to make sure all the vaccines are covered in the same sitting or after a week, since there will be 2-3 injections now. Other than this no problem.
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hi,
for my baby, the next scheduled vaccination is at 14 weeks. in the last two vaccinations (6 weeks and 10 weeks) she was not given IPV 1 and 2.
How should i choose her vaccination schedule for 3 IPV injections starting 14 weeks
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What is the reason she was not given IPV?
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Hi,
For my 6 weeks baby we vaccinated
Pentavac,rotavac , synflorix (pcv1) and instead of IPV Dr given OPV so is it O.k and my 2 question is should I go for pentaxim,rotavac and synflorix (pcv2) in 10 th week vaccination
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You have to definitely give IPV. Just giving OPV is not enough.
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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
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Hi,
Yes, hepatitis B schedule is 0, 1, 6 months. But since pentavac which already has hepatitis B can be given at 10th week, no harm in it. Do discuss with your pediatrician in detail, regarding the doses and also the 6th month hepatitis B Vaccine.
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Thanks for the advice.
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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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If the painful vaccine is causing too much of a discomfort then you can shift to a painless one provided all the vaccines are given as per schedule. Otherwise continue with the painful one.
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Madam, can we go for hexaxim at 6 week and pentaxim at 10 and 14 (excluding rota and PCV)
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Try to stick to the same brand through out, though you can administer different brand or composition in unavoidable circumstances.
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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..
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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.
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thats really good to hear . thanks alot..
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Useful information
Thanks!!!
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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.
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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?
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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!
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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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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?
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As such there is no problem, if vaccines are chosen correctly. But rather than asking for painless or painful, do ask the brand names. And yes, compositions will differ with different brands.
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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….
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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?
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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
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Pentavac does not contain IPV hence it has to be given seperately. OPV is oral polio vaccine, and given as 2 drops orally to the baby, which also has to be given to the baby
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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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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.
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Infanrix hexa is a vaccine against 6 diseases whereas pentavac is against 5 diseases. It won’t make much of a difference.
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Thank you mam.we have injected last week.any problem in the baby health.
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It is quite a safe vaccine
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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
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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
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Realy nice information most confusion arise from government schedule and IAP schedule for vaccination both r different which one is better?
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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.
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Thanks a lot for the information.
Keep up the good work.
One question :Is painless vaccination banned in India?
Please guide.
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It’s not banned and regularly used in India
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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
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If you have already given 2 doses of pentavac, I suggest you continue with it, provided she doesn’t have any side effects.
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please reply.
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Hello mam,
In my city painless vaccine price is 4800 is it right price or more?
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Can you give more details regarding brand and city?
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thanks a lot
very informative article.
i have given my baby ist dose of easy five at 6 week . we have shifted to another city where doc recommend pentaxim. we injected it as it was less painful. now for 3rd dose im not sure which one to give easy five or pentaxim. and wht abt hep b schedule if i prefer pentaxim or easy five in last dose.will there be any difference.
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Hello
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Thank u so much
For information regarding painless and painful vaccines.
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You are welcome
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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
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Intramuscular injections are commonly given on the thigh in infants and toddlers
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Well the vaccines, specially dtp is no more recommended to be given on buttocks. It is said that the fat in the buttock reduces the absorption of the vaccine. So the current recommended practice s to give t on the thigh
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This was an awesome article…Keep up the good work
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Thank you😊
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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.
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Thanks for the appreciation!!!
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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!!
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Thanks for you kind words!!!
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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.
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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
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