II. Epidemiology

  1. Diphtheria Incidence
    1. U.S.: Only 5 cases since 2000
    2. Entire Soviet Union (1982) 340 cases
    3. Russia alone (1994) 40,000 cases
  2. Pertussis
    1. Pertussis Vaccine first available in 1940
    2. Incidence in U.S. reached a low of 1020 cases 1976
    3. Increasing in Incidence in U.S. over subsequent years since 1970s related to mutating PertussisBacteria
    4. Incidence in U.S. 13,000 and 41,000 cases/year between 2007 and 2012
      1. Two thirds of cases occur in teens and adults
      2. Adult cases often mild, but infant cases are severe and a mortality risk
  3. Tetanus
    1. On average 29 cases in U.S. per year

III. Indications

  1. Acellular PertussisVaccine approved for all ages
  2. Should be used in Primary Series

IV. Contraindications: DTP or DTaP administration

  1. Absolute: Severe reaction following prior DTP or DTaP
    1. Immediate Anaphylaxis
    2. Encephalopathy within 7 days of Vaccine
  2. Relative: Moderate Reaction following prior DTP or DTaP
    1. Fever > 40.5 C within 48 hours of Vaccine
    2. Guillain-Barre Syndrome within 6 weeks of Vaccine
    3. Seizure within 72 hours of Vaccine
      1. May have repeat doses if no associated encephalopathy, coma or prolonged serious symptoms
      2. Seizure Disorders and Infantile Spasms should be stable before administering DTaP dose
    4. Hypotonic or Unresponsive Episode within 48 hours
      1. No longer considered a contraindication to future Vaccination
    5. Inconsolable Crying >3 hours within 48 hours
      1. No longer considered a contraindication to future Vaccination
  3. Conditions not contraindicating Vaccine
    1. Family History of adverse Vaccine event
    2. Family History of SIDS
    3. Family of Seizure Disorder
    4. Fever following prior Vaccine <40.5 C (105 F)
  4. If Vaccine Contraindicated, then
    1. Allergy Testing for anaphylactic reaction
    2. Administer DT to all other groups

V. Efficacy (after 3 doses)

  1. Cellular Vaccine: only 50% effective
  2. Acellular Vaccine: 85% effective
    1. Immunity wanes by as much as 42% per year since last DTaP
    2. Klein (2012) N Engl J Med 367(11): 1012-9 [PubMed]

VI. Preparations (Use one consistently for Primary Series)

  1. DTaP (Daptacel, Infanrix)
    1. Age 6 weeks to 6 years
    2. Given as part of Primary Series (at 2, 4, 6, and 12-15 months and 4 to 6 years)
  2. DTaP/HepB/IPV (Pediarix)
    1. Age 6 weeks to 6 years
    2. Given as part of Primary Series (at 2, 4 and 6 months)
  3. DTaP/IPV (Kinrix, Quadracel)
    1. Ages 4 to 6 years old (for fourth IPV and fifth DTaP)
  4. DTaP/IPV/PRP-T (Pentacel)
    1. Ages 6 weeks to 4 years
    2. Given as part of Primary Series (at 2, 4, 6, and 12-15 months)
  5. Other Vaccines (not used for Primary Series)
    1. See Td Vaccine (Tetanus Diphtheria Vaccine)
      1. Used for Tetanus booster in adults
    2. See Tdap Vaccine (Adacel, Boostrix)
      1. Use TdaP instead of DTaP after age 7 years old

VII. Schedule: Primary Series with DTaP Vaccine

  1. Last 2 doses must be at least 6 months after the prior dose
  2. Dose 1: 2 months
  3. Dose 2: 4 months
  4. Dose 3: 6 months
  5. Dose 4: 15 to 18 months (may be given as early as 12 months but must be >6 months after third dose)
  6. Dose 5: 4 to 6 years
    1. Dose 5 is not needed if dose 4 given at age >4 years AND dose 3 and 4 were at least 6 months apart

VIII. Adverse Effects: Acellular Vaccine

  1. Marked reduction in adverse effects
  2. Local reaction at injection site
  3. Reactions are more common with the fourth and fifth doses
    1. Fever and injection site reaction (fourth dose)
    2. Swelling of injection site for up to 7 days (fourth and fifth doses)
  4. Compare with whole cell Vaccine
    1. Lower fever
    2. Very low to no Incidence of Seizures or shock state
  5. Safety
    1. No association with Type I Diabetes, seziures, Encephalitis, Autism or Infantile Spasms

IX. Adverse Effects: Whole cell Vaccine

  1. Mild Reaction to Vaccine (75%)
    1. Local ache
    2. Induration
    3. Fever (<39.5)
  2. Moderate
    1. Fever >40.0-40.5
    2. Excess Somnolence
    3. Inconsolable crying >4 hours
  3. Severe
    1. Neurologic changes within 3 days of Vaccine
    2. Convulsions
    3. Acute encephalopathy

X. Dosage Protocols

  1. Not compatible with HaemophilusInfluenza B Vaccine
    1. Reduced immunogenicity when mixed acellular Pertussis
  2. References
    1. 1996 N Engl J Med 334:341-55,391-2 [PubMed]
    2. 1996 JAMA 275:37 [PubMed]

XI. Resources

  1. CDC Immunization Schedules (last accessed 10/28/2020)
    1. https://www.cdc.gov/vaccines/schedules/

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Ontology: Diphtheria-Tetanus-acellular Pertussis Vaccines (C0535644)

Definition (MSH) Combined vaccines consisting of DIPHTHERIA TOXOID; TETANUS TOXOID; and an acellular form of PERTUSSIS VACCINE. At least five different purified antigens of B. pertussis have been used in various combinations in these vaccines.
Concepts Pharmacologic Substance (T121) , Immunologic Factor (T129)
MSH D022681
SnomedCT 429321000124106
Swedish Difteri-stelkramp-acellulära kikhostevacciner
Czech diftérie-tetanus-acelulární pertuse - vakcíny, DTaP vakcíny
Finnish Soluttomat PDT-rokotteet
English diphtheria, tetanus, and acellular pertussis (DTaP) vaccine, diphtheria, tetanus, and acellular pertussis (DTaP) vaccine (medication), Diphtheria-Tetanus-acellular Pertussis Vaccines [Chemical/Ingredient], dtap vaccine, Pertussis Vaccines, Diphtheria-Tetanus-acellular, Vaccine, DTaP, Vaccines, DTaP, Vaccines, Diphtheria-Tetanus-acellular Pertussis, DTaP Vaccine, DTaP Vaccines, Diphtheria Tetanus acellular Pertussis Vaccines, Diphtheria-Tetanus-acellular Pertussis Vaccines, DTaP - diphtheria + tetanus + acellular pertussis vaccine, Diphtheria + tetanus + acellular pertussis vaccine (product), Diphtheria + tetanus + acellular pertussis vaccine
Japanese ワクチン-ジフテリア・破傷風・無細胞百日咳, ジフテリア・破傷風・無細胞百日咳ワクチン, DTaPワクチン, ジフテリア-破傷風-無細胞百日咳ワクチン, ワクチン-DTaP, ワクチン-ジフテリア-破傷風-無細胞百日咳
Italian Vaccini DTaP, Vaccino DTaP, Vaccini tetanici, difterici e pertossici acellulari
Polish Szczepionki bezkomórkowe przeciw błonicy tężcowi krztuścowi
Spanish Vacunas Antidiftéricas, Antitetánicas y Antipertussis Acelular, Vacunas Antidiftéricas, Antitetánicas y Antitos Ferina Acelular, Vacunas contra Difteria, Tétanos y Pertussis Acelular, Vacunas DTaP, Vacunas contra Difteria, Tétanos y Tos Ferina Acelular
Portuguese Vacinas Antidiftéricas, Antitetânicas e Anticoqueluche Acelular, Vacinas Antidiftéricas, Antitetânicas e Antipertússis Acelular, Vacinas contra Difteria, Tétano e Pertússis Acelular, Vacinas DTaP, Vacinas contra Difteria, Tétano e Coqueluche Acelular
German DTaP-Impfstoffe, DTaP-Vakzinen, Diphtherie-Tetanus-azelluläre-Pertussis-Vakzine, Impfstoffe, Diphtherie-Tetanus-azelluläre Pertussis
French Vaccins DTCa, Vaccins diphtérique tétanique coquelucheux acellulaires