Diphteria, Tetanus, Accelular pertussis

PEDIATRIC ADVISOR: IMMUNIZATION - DIPHTERIA, TETANUS, WHOOPING COUGH /+/- POLIO, HiB, HBV/
Your child has been given a vaccination which will help protect against diphteria, whooping cough and tetanus. In addition may be given polio, HiB and hepatitis B injectible vaccine, which will help to protect your child from polio, hemophilus type B and hepatitis B. Some of the children who receive such a vaccination will have some fever on the first night following the immunization. Swelling may occur at the injection site. If swelling occurs apply a cool cloth 2-3 times a day. If the swelling lasts longer than 2 days, please telephone us. Sometimes a very small bump (about the size of a pea) will appear and last for several weeks. It should be checked if it becomes red or tender.

Why get vaccinated?
Diphteria, tetanus and pertussis are serious diseases caused by bacteria. Diphteria and pertussis are spread from person to person, tetanus enters the body mainly through cuts and wounds. Diphteria can lead to breathing problems, paralysis, heart failure and death. Tetanus causes painful tightening of the muscles and may lead to death. Pertussis /whooping cough/ causes coughing spells, pnuemonia, sizures, brain demage and death. DTP vaccine may be distinguished as "DTwP" and "DTaP", with "wP" referring to "whole cell pertussis" and "aP" or "Pa" referring to "acellular pertussis". The acellular form is considered safer and contains far fewer antigens than the older preparation. DTaP vaccine is licensed for children under 7. Tdap vaccine can protect adolescents and adults. As indicated by the lower case "d" and "p", the concentration of diphtheria and pertussis toxoids has been reduced in these formulations to prevent adverse reactions. DTaP vaccine is available as Infanrix. The usual course of immunization is five doses between 3 months and 5 years. Tdap vaccine is available as Adacel or Boostrix.
It is wise to recommend adolescents and adults receive Tdap in place of their next tetanus (T) booster (recommend to be given every 10 years). Tdap can be used as prophylaxis for tetanus wound management. Five years between doses of T and Tdap is the current standard of care; frequent exposure to tetanus toxoid can cause local reactions. People who will be in contact with young infants are encouraged to get Tdap even if it has been less than 5 years since T to reduce the risk of infants being exposed to pertussis.
Diphteria, tetanus, pertussis and related vaccines:
INFANRIX HEXA - Diphteria, Tetanus, Acellular Pertussis, Haemophillus influenzae, Polio, Hepatitis B
INFANRIX HIB - Diphteria, Tetanus, Acellular Pertussis, Haemophillus influenzae
INFANRIX - Diphteria, Tetanus, Acellular Pertussis - it is available for children up to 7 years of age
ALTEANA, TETAVAX - Tetanus
Who should get DTaP vaccine and when?
Children should get 5 doses of DTaP vaccine, one dose at each of the following ages:
3 months, 4 months, 5 months, 18 months, 5 years
DTaP may be given at the same time as other vaccines
Some children should not get DTaP vaccine or should wait
Children with minor illnesses, such as cold, may be vaccinated. But children who are moderately or severely il should usually wait until they recover before getting DTaP vaccine.
Any child who had a life-threatening allergic reaction after a dose of DTaP should not get another dose
Any child who suffered a brain or nervous system disease within 7 days after a dose of DTaP should not get another dose
Talk with your doctor if your child:
- had a seizure or collapsed after a dose of DTaP
- cried non-stop for 3 hours or more after a dose of DTaP
- had a fever over 105dgF after a dose of DTaP
Ask your health care provider for more information. Some of these children should not get another dose of pertussis vaccine, but may get a vacine without pertussis
Older children and adults
DTaP should not be given to anyone 7 years of age or older because pertussis vaccine is only licensed for children under 7.
But older children adolescents, and adults, still need protection from tetanus and diphteria. There is separate Vaccine information statement.
What are the risks from DTaP vaccine?
Getting diphteria, tetanus, or pertussis disease is much riskier than getting DTaP vaccine.
However, a vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of DTaP vaccine causing serious harm, or death, is extremely small.
Mild problems /common/:
- fever /up to about 1 child in 4/
- redness or swelling where the shot was given /up to about 1 child in 4/
- soreness and tenderness where the shot was given /up to about 1 child in 4/
These problems occur more often after 4th and 5th dose of the DTaP series than after earlier doses. Sometimes the 4th and 5th dose of DTaP vaccine is followed by swelling of the entire arm or leg in which the shot was given, lasting 1-7 days
Other mild problems include:
- fussiness /up to 1 child in 3/
- tiredness or poor appetite /up to about 1 child in 10/
- vomiting /up to about 1 child in 50/
These problems generally occur 1-3 days after the shot
Moderate problems /uncommon/:
- seizure /jerking or staring/ about 1 child out of 14,000
- non-stop crying, for 3 hours or more /up to about 1 child out of 1000/
- high fever, ovr 105dgF /about 1 child out of 16000/
Severe problems /very rare/:
- serious allergic reaction /less than 1 out of a million doses/
- several other severe problems have been reported after DTaP vaccine. These include: long-term seizures, coma, or lowered consciousness, permanent brain demage. These are so rare it is hard to tell if they are caused by the vaccine
Controlling fever is especially important for children who have had seizures, for any reason. It is also important if another family member has had seizures. You can reduce fever and pain by giving your child an aspirin-free pain reliever when the shot is given, and for the next 24 hours, following the package instrutions.
What if there is a moderate or severe reaction?
What should I look for?
Any unusual conditions, such as a serious allergic reaction, high fever or unusual behavior. Serious allergic reaction are extremely rare with any vaccine. If one were to occur, it would most likely be within a few minutes to a few hours after the shot. Signs can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness. If a high fever or seizure were to occur, it would usually be within a week after the shot.
What should I do?
Call your doctor or get the person to a doctor right away.

Tdap vaccine for adolescents and adults

Why get vaccinated?
Tdap /tetanus, diphteria, pertussis/ vaccine can protect adolescents and adults against three serious diseases.
In 2004 there were more than 25 000 cases of pertussis in the U.S. More than 8 000 of these cases were among adolescents and more than 7 000 were among adults. Up to 2 in 100 adolescents and 5 in 100 adults with pertussis are hospitalized or have complications.
Diphteria, tetanus, pertussis and related vaccines:
ALTEANA - /T- tetanus/
BOOSTRIX - /Tdap - Tetanus, Diphteria, Acellular Pertussis/ - is available for children older than 4 years, adolescents and adults
BOOSTRIX POLIO - /Tdap-IPV - Tetanus, Diphteria, Acellular Pertussis, Polio/ - is available for children older than 4 years, adults and adolescents
Who should get T or Tdap vaccine and when?
A dose of T is recommended for adults who got DTaP or DTP as children but have not yet gotten a dose of T. The preffered time is every 10 years.
Children older than 7 years and adolescents who did not get all their scheduled doses of DTaP or DTP as children should complete the series using combination of Tdap.
Health care workers who have direct patient contact in hospitals or clinics should get a dose of Tdap.
An adolescent or adult who gets a severe cut or burn might need protection against tetanus infection.
Tdap may be given at the same time as other vaccines.
Some people should not get Tdap vaccine or should wait.
Anyone who has had a life threatening allergic reaction after a dose of DTP, DTaP, DT, or Td vaccine should not get Tdap
Anyone who has a severe allergy to any component of the vaccine should not get Tdap. Tell your health care provider if the person getting the vaccine has any known severe allergy. Talk with your doctor if the person getting the vaccine has severe allergy to latex. Some Tdap vaccines should not be given to people with severe latex allergy.
Anyone who went into a coma or had a long seizure within 7 days after a dose of DTP or DTaP should not get Tdap, unless a cause other than the vaccine is found
Talk to your doctor if the person getting the vaccine has epilepsy or central nervous system problem, had severe swelling or severe pain after a previous dose of any vaccine containing tetanus, diphteria or pertussis, has had Guilain-Barré Syndrome
Anyone who has a moderate or severe illness on the day the shot is scheduled usually wait until they recover before getting the vaccine.
What are the risks from Tdap vaccine?
A vaccine like any medicine, could possibly cause serious problems, such as severe allergic reactions. However, the risk of a vaccine causing serious harm, or death, is very small. Like all vaccines, Tdap is being closely monitored for unusal and severe problems.
Mild problems /noticiable but did not interfere with activities/
- pain /about 3 in 4 adolescents and 2 in 3 adults/
- redness and swelling /about 1 in 5/
- mild fever of at least 100,4dgF /up to about 1 in 25 adolescents and 1 in 100 adults/
- headache /about 4 in 10 adolescents and 3 in 10 adults/
- tiredness /about 1 in 3 adolescents and 1 in 4 adults/
- nausea, vomitting, diarrhea, stomach ache /up to 1 in 4 adolescents and 1 in 10 adults/
- other mild problems reported include chills, body ache, sore joints, rash and swolen lymph glands/
Moderate problems /interfere with activities but did not require medical attention/
- pain at the injection site / about 1 in 20 adolescents and 1 in 100 adults/
- redness and swelling /up to 1 in 16 adolescents and 1 in 250 adults/
- nausea, vomitting, diarrhea, stomach ache /up to 3 in 100 adolescents and 1 in 100 adults/
- headache /1 in 300/
Severe problems /unable to perform usual activities, required mdical attention/
None were seen among adolescents. In the adult clinical trial, two adults had nervous system problems after getting the vaccine. They went away on their own and did not cause any permanent harm. A severe allergic reaction could occur after any vaccine. They are estimated to occur less than once in a million doses. A person who gets these diseases is much more likely to have severe complications than a person who gets Tdap vaccine .
What if there is moderate or severe reaction?
Any unusual condition, such as high fever or behavior changes. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.
What should I do?
Call the doctor or get the person to a doctor right away.