Can Kinrix (diphtheria, tetanus, and pertussis (DTaP) and polio (IPV) vaccine) be used for the 4th dose of DTaP in a pediatric patient?

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Kinrix for the 4th Dose of DTaP

No, Kinrix is NOT indicated for the 4th dose of DTaP—it is specifically licensed only for the 5th dose of DTaP (and 4th dose of IPV) in children aged 4-6 years. 1

FDA-Licensed Indication

Kinrix is FDA-approved exclusively as the 5th dose of the DTaP vaccine series and the 4th dose of the IPV series in children aged 4-6 years. 1 The ACIP guidance explicitly states this limitation and specifies that Kinrix should be used only when:

  • The first 3 DTaP doses were Infanrix and/or Pediarix 1
  • The 4th DTaP dose was Infanrix 1

Age and Dosing Restrictions

Kinrix should not be administered to children aged <4 years or >7 years. 1 This age restriction means it cannot be used for the 4th dose, which is typically given at 15-18 months of age. 1

What to Use for the 4th Dose Instead

For the 4th dose of DTaP at 15-18 months, appropriate options include:

  • Infanrix (standalone DTaP) 2
  • Daptacel (standalone DTaP) 1
  • Pentacel (DTaP-IPV/Hib combination), which is specifically licensed for use at ages 2,4,6, and 15-18 months 1

Important Clinical Caveat: Inadvertent Administration

If Kinrix is inadvertently administered for the 4th dose (or any earlier dose), the dose should be counted as valid and does not need to be repeated, provided minimum interval requirements have been met. 1 This pragmatic guidance prevents unnecessary revaccination while acknowledging the off-label use should be avoided prospectively.

Interchangeability Considerations

While the same manufacturer's DTaP vaccine should be used throughout the series whenever feasible, vaccination should never be deferred if the specific brand previously administered is unavailable or unknown. 1 Limited data exist on interchanging DTaP vaccines from different manufacturers, but available evidence suggests mixed sequences are safe and immunogenic. 3

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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