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Hexavalent vaccines against diphtheria (D), tetanus (T), pertussis (P), hepatitis B (HBV), polio (IPV) and Haemophilus influenzae b (Hib) are established in the immunization of infants in many countries. A metaanalysis of results from six head-to-head clinical trials comparing two hexavalent vaccines reported that the rate of three local (redness, pain and swelling at the injection site) and five systemic (fever, drowsiness, persistent crying, irritability and anorexia) adverse reactions was lower for the DT3aP-HBV-IPV/Hib vaccine than for the DT2aP-HBV-IPV-Hib vaccine. The objective of this analysis was to compare the impact of adverse reactions after a single dose of the primary series of DT3aP-HBV-IPV/Hib vaccine versus DT2aP-HBV-IPV-Hib vaccine in the infant populations of four countries in Southeast Asia (Indonesia, Malaysia, the Philippines and Thailand). A previously published mathematical projection tool was combined with published data to estimate the number of adverse reactions potentially avoided in 2023 by using DT3aP-HBV-IPV/Hib vaccine compared with DT2aPHBV-IPV-Hib vaccine. The results indicated that for every 100 infants vaccinated, using DT3aP-HBV-IPV/Hib instead of DT2aP-HBV-IPV-Hib would be expected to avoid adverse reactions, ranging from 3 events of swelling at the injection site to 10 events of fever. In 2023, over 280,000 solicited local and systemic adverse reactions of any grade could have been avoided in Indonesia, over 200,000 in Malaysia, over 80,000 in Thailand and over 158,000 in the Philippines. These results could be useful to healthcare decision-makers considering immunization strategies in Southeast Asia. [ABSTRACT FROM AUTHOR]