Diphtheria-Tetanus-Pertussis Vaccine

Diphtheria (D) vaccines contain toxoids prepared from Corynebacterium diphtheriae. Tetanus (T) vaccines contain toxoids prepared from Clostridium tetani. Acellular (a) pertussis (P) vaccines contain semipurified or purified components of Bordetella pertussis

• Diphtheria-tetanus-acellular pertussis (DTaP) for children < 7 years

• Tetanus-diphtheria-pertussis (Tdap) for adolescents and adults

Tdap contains lower doses of diphtheria and pertussis components (indicated by the lower case d and p).

DTaP is a routine childhood vaccination (see CDC: Child and Adolescent Immunization Schedule by Age).

Tdap is routinely given as a single lifetime dose to children at age 11 or 12 years and to people ≥ 13 years who have never received Tdap (regardless of the interval since the last tetanus-diphtheria [Td] vaccine) or whose vaccine status is unknown. This dose is followed by a Td booster every 10 years (see CDC: Adult Immunization Schedule by Age).

Additional boosters of Tdap are also recommended for

• Pregnant women during each pregnancy (preferably at 27 to 36 weeks gestation), regardless of the interval since any previous dose of Tdap

• Postpartum women who have never received Tdap

Adults who require a tetanus toxoid-containing vaccine as part of wound management and who have not previously received Tdap are given Tdap instead of tetanus-diphtheria (Td). Those who have previously received Tdap may be given Tdap or Td.

People who have had pertussis should still receive a pertussis-containing vaccine as per routine recommendations.

Contraindications for DTaP and Tdap are

• A severe allergic reaction (eg, anaphylaxis) after a previous dose or to a vaccine component

• For the pertussis component: Encephalopathy (eg, coma, decreased level of consciousness, prolonged seizures) that occurred within 7 days of a previous dose of DTaP or Tdap and that is not attributable to another identifiable cause

Because tetanus vaccination is important, people who have had an anaphylactic reaction to components in DTaP or Tdap should be referred to an allergist to determine whether they are allergic to tetanus toxoid. If not, they can be vaccinated with tetanus toxoid (TT) vaccine. Adults with a history of encephalopathy can be vaccinated with tetanus-diphtheria, and children can be given diphtheria-tetanus (DT) instead of Tdap.

Precautions vary depending on the formulation.

For DTaP and Tdap, they include

• Moderate or severe acute illness with or without fever (vaccination is postponed until illness resolves if possible)

• Guillain-Barré syndrome within 6 weeks after a previous dose to a vaccine containing tetanus toxoid

• For the pertussis component only: A progressive or unstable neurologic disorder, uncontrolled seizures, or progressive encephalopathy (vaccination is postponed until a treatment regimen is established and the disorder is stabilized)

For DTaP only, precautions include

• A seizure, with or without fever, within 3 days after a previous dose of DTaP

• ≥ 3 hours of persistent, severe, inconsolable screaming or crying within 48 hours after a previous dose of DTaP

• Collapse or shock-like state (hypotonic hyporesponsive episode) within 48 hours after a previous dose of DTaP

• Temperature of ≥ 40.5° C, unexplained by another cause, within 48 hours after a previous dose of DTaP

For Tdap only, precautions include

• History of type III hypersensitivity reactions after a previous dose of a vaccine containing tetanus or diphtheria toxoid (vaccination is postponed ≥ 10 years since the last dose of tetanus toxoid-containing vaccine)

The dose for DTaP or Tdap is 0.5 mL IM.

The DTaP vaccine is given as 5 primary and 1 booster IM injections during childhood as follows: at age 2 months, 4 months, 6 months, 15 to 18 months, and 4 to 6 years (before school entry). The fifth dose is not necessary if the fourth dose was given at age ≥ 4 years and at least 6 months after the third dose.

A single booster of Tdap is given, except for pregnant women, who should have a dose during each pregnancy, preferably at 27 to 36 weeks gestation.

Adverse effects are rare and are mostly attributable to the pertussis component. They include the following:

• Encephalopathy within 7 days

• A seizure, with or without fever, within 3 days

• ≥ 3 hours of persistent, severe, inconsolable screaming or crying within 48 hours

• Collapse or shock within 48 hours

• Temperature of ≥ 40.5° C, unexplained by another cause, within 48 hours

• Immediate severe or anaphylactic reaction to the vaccine

If the pertussis vaccine is contraindicated, a combined diphtheria and tetanus vaccine is available without the pertussis component.

Mild adverse effects include redness, swelling, and soreness at the injection site.

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

1. Advisory Committee on Immunization Practices (ACIP): DTaP/Tdap/Td ACIP Vaccine Recommendations

2. Centers for Disease Control and Prevention (CDC): Diphtheria, Tetanus, and Pertussis Vaccination: Information for Healthcare Professionals

3. European Centre for Disease Prevention and Control (ECDC): Diphtheria: Recommended vaccinations

4. European Centre for Disease Prevention and Control (ECDC): Tetanus: Recommended vaccinations

5. European Centre for Disease Prevention and Control (ECDC): Pertussis: Recommended vaccinations