DPT vaccine

The DPT vaccine (DPT) is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis (whooping cough), and tetanus.[1] The vaccine components include diphtheria and tetanus toxoids and either killed whole cells of the bacterium that causes pertussis or pertussis antigens. The whole cells or antigens will be depicted as either "DTwP" or "DTaP", where the lower-case "w" indicates whole-cell inactivated pertussis and the lower-case "a" indicates pertussis antigens.[2]

"TDAP" redirects here. For other uses, see TDAP (disambiguation).
See also: DTP vaccine

DPT vaccine
Combination of
Diphtheria vaccineVaccine
Pertussis vaccineVaccine
Tetanus vaccineVaccine
Clinical data
Trade namesAdacel, Boostrix, others
Legal status
Legal status
  • AU: S4 (Prescription only)
  • US: ℞-only
  • In general: ℞ (Prescription only)
Identifiers
ChemSpider
  • none
 NY (what is this?)  (verify)

In the United States, the DPT vaccine is administered as part of the childhood vaccines recommended by the Centers for Disease Control and Prevention (CDC).[3]

Immunization schedule

The standard immunization regimen for children within the United States is five doses of DTaP between the ages of two months and fifteen years.[4] The CDC recommends that children receive their first dose at two months, the second dose at four months, the third dose at six months, the fourth dose between 15-18 months, and the fifth dose between 4-6 years.[3]

For adults who have received their childhood DTP series, a Td or Tdap booster is recommended every ten years.[5][6] For adults that have not received the DTP series, the CDC recommends a three-part vaccine series followed by a Td or Tdap booster every ten years.[5]

Contraindications

The DPT vaccine should be avoided in persons who experienced a severe allergic reaction (anaphylaxis) to a past vaccine containing tetanus, diphtheria, or pertussis. It should also be avoided in persons with a known severe allergy to an ingredient in the vaccine. If the reaction was caused by tetanus toxoids, the CDC recommends considering a passive immunization with tetanus immune globulin (TIG) if a person has a dirty and/or large wound.[7] The DPT vaccine should also be avoided if a person developed encephalopathy (seizures, coma, declined consciousness) within 7 days of receiving any pertussis-containing vaccine and the encephalopathy cannot be traced to another cause.[8] A DT vaccine is available for children under the ages of 7 who have contraindications or precautions to pertussis-containing vaccines.[9]

History

In the 20th century, the advancements in vaccinations helped to reduce the incidence of childhood pertussis and had a dramatically positive effect on the health of populations in the United States.[10] However, in the early 21st century, reported instances of the disease increased 20-fold due to a downturn in the number of immunizations received and resulted in numerous fatalities.[11] During the 21st century, many parents declined to vaccinate their children against pertussis for fear of perceived side effects despite scientific evidence showing vaccines to be highly effective and safe.[11] In 2009, the journal Pediatrics concluded the largest risk among unvaccinated children was not the contraction of side effects, but rather the disease that the vaccination aims to protect against.[11]

The Diphtheria and tetanus toxoids and pertussis (DTP) vaccination was licensed in 1949.[12]

Combination vaccines with acellular pertussis

DTaP and Tdap are both combination vaccines against diphtheria, tetanus, and pertussis. The lower-case "d" and "p" indicate smaller concentrations of diphtheria toxoids and pertussis antigens, and "a" in "ap/aP" indicates that the pertussis toxoids are acellular.[13]

DTaP

DTaP (also DTPa and TDaP) is a combination vaccine against diphtheria, tetanus, and pertussis, in which the pertussis component is acellular.[14] This is in contrast to whole-cell, inactivated DTP (DTwP).[15] The acellular vaccine uses selected antigens of the pertussis pathogen to induce immunity.[16] Because it uses fewer antigens than the whole-cell vaccines, it is considered to cause fewer side effects, but it is also more expensive.[16] Research suggests that the DTP vaccine is more effective than DTaP in conferring immunity, because DTaP's narrower antigen base is less effective against current pathogen strains.[17]

Tdap

Tdap, (also dTpa), is a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine. It was licensed in the United States for use in adults and adolescents on June 10, 2005.[18] Two Tdap vaccines are available in the US. In January 2011, the US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommended the use of Tdap in adults of all ages, including those age 65 and above.[19] In October 2011, in an effort to reduce the burden of pertussis in infants, the ACIP recommended that unvaccinated pregnant women receive a dose of Tdap. On October 24, 2012, the ACIP voted to recommend the use of Tdap during every pregnancy.[20][21]

The ACIP and Canada's National Advisory Committee on Immunization (NACI) recommended that both adolescents and adults receive Tdap in place of their next Td booster (recommended to be given every ten years).[22][23][24][18] Tdap and Td can be used as prophylaxis for tetanus in wound management. People who will be in contact with young infants are encouraged to get Tdap even if it has been less than five years since Td or TT to reduce the risk of infants being exposed to pertussis. NACI suggests intervals shorter than five years can be used for catch-up programs and other instances where programmatic concerns make five-year intervals difficult.[25]

The World Health Organization (WHO) recommends a pentavalent vaccine, combining the DTP vaccine with vaccines against Haemophilus influenzae type B and hepatitis B. Evidence on how effective this pentavalent vaccine is compared to the individual vaccines has not yet been determined.[26]

A 2019 study in the American Economic Journal found that state requirements mandating the use of the Tdap vaccine "increased Tdap vaccine take-up and reduced pertussis (whooping cough) incidence by about 32 percent."[27]

Side effects

DTaP

Common side effects include soreness where the shot was given, fever, irritability, tiredness, loss of appetite, and vomiting.[14] Most side effects are mild to moderate and may last from one to three days [14] More serious but rare reactions after a DTaP vaccination may include seizures, lowered consciousness, or a high fever over 105 °F (41 °C).[1]

Tdap

Common side effects include pain or swelling where the shot was given, mild fever, headache, tiredness, nausea, vomiting, diarrhea, and stomach ache.[14] Any individual who has experienced a life-threatening allergic reaction after receiving a previous dose of diphtheria, tetanus, or pertussis containing vaccine should not receive the Tdap vaccination.[14]

In pregnancy

According to the CDC's Advisory Committee on Immunization Practices (ACIP) guidelines, one dose of Tdap is recommended during each pregnancy to ensure protection against pertussis in newborn infants.[28] Optimal timing to administer a dose of Tdap during each pregnancy is between 27 through 36 weeks gestation.[28] If Tdap is administered early in pregnancy, it is not recommended to administer again during the 27 through 36 weeks gestation period as only one dose is recommended during pregnancy.[29]

Pregnant women who have not previously vaccinated with Tdap (i.e., have never received DTP, DTaP, or DT as child or Td or TT as an adult) are recommended to receive a series of three Td vaccinations starting during pregnancy to ensure protection against maternal and neonatal tetanus.[30] In such cases, administration of Tdap is recommended after 20 weeks' gestation,[31][21] and in earlier pregnancy a single dose of Tdap can be substituted for one dose of Td, and then the series completed with Td.[30][21] For women not previously vaccinated with Tdap, if Tdap is not administered during pregnancy, it should be administered immediately postpartum. [32]

Infants younger than 12 months of age, specifically less than three months of age are at highest risk of acquiring pertussis. [33] In U.S, there is no current tetanus-diptheria-pertussis vaccination (whooping cough) recommended or licensed for new born infants.[33] As a result, in their first few months of life, unprotected infants are at highest risk of life-threatening complications and infections from pertussis. Infants should not receive pertussis vaccination younger than six weeks of age. [34] Ideally, Infants should receive DTaP (name of whooping cough vaccine for children from age 2 months through 6 years) at 2, 4, 6 months of age and they are not protected until the full series is completed. [33] To protect infants younger than twelve months of age not vaccinated with Tdap against pertussis, ACIP also recommends, adults (e.g., parents, siblings, grandparents, childcare providers, and healthcare personnel) and children to receive Tdap at least two weeks before being in contact with the infant.[32]

Other related vaccines include the DT and Td vaccines, which lack the pertussis component.[35][36][37] The Td vaccine is administered to children over the age of seven as well as to adults. It is most commonly administered as a booster shot every 10 years.[35] The Td booster shot may also be administered as protection from a severe burn or dirty wound.[35]

In the United Kingdom, the Netherlands, and France, the DTP vaccine is a combination vaccine against diphtheria, tetanus, and poliomyelitis. In the Netherlands, pertussis is known as kinkhoest and DKTP refers to a combination vaccine against diphtheria, kinkhoest, tetanus, and polio.[38]

Society and culture

Brand names

United States

As of January 2020, there are six DTaP vaccines and two Tdap vaccines licensed and available for use in the United States.[39][40] All of them are indicated as childhood vaccinations with the schedules as follows:

DTaP Vaccines in the US
Trade nameApproval dateComments Contraindications
Daptacel[41]2002[42]For use in ages six weeks through six years as a five-dose series at 2, 4, and 6 months (6–8 weeks apart) and at 15–20 months of age and at 4–6 years.[41]
  • Severe allergic reaction (anaphylaxis) after a previous dose of Daptacel or tetanus, diphtheria, or pertussis containing vaccine.
  • Encephalopathy (coma, prolonged seizures, and decreased level of consciousness) within seven days of a previous dose of a pertussis containing vaccine.
  • Progressive neurologic disorder (spasms, epilepsy, progressive encephalopathy)[41]
Infanrix[43]1997[44]For use in ages six weeks through six years (before the seventh birthday) as a five-dose series as: a three-dose course at 2, 5, and 6 months (4–8 weeks apart), followed by a two booster doses at 15–20 months of age and 4–6 years of age.[43]
  • Severe allergic reaction (anaphylaxis) after a previous dose of Infanrix or tetanus, diphtheria, or pertussis-containing vaccine.
  • Encephalopathy (coma, prolonged seizures, and decreased level of consciousness) within seven days of a previous dose of a pertussis containing vaccine.
  • Progressive neurologic disorder (spasms, epilepsy, progressive encephalopathy)[43]
Kinrix[45]2008[46]DTaP-IPV vaccine; also immunizes against poliomyelitis. Kinrix can be utilized for the fifth (last) dose in the DTaP immunization series and the fourth dose in the IPV immunization series in children 4–6 years old (before the seventh birthday) whose previous DTaP vaccine doses have been with Infanrix and/or Pediarix for the first three doses and Infanrix for the fourth dose.[45]
  • Severe allergic reaction (anaphylaxis) after a previous dose of any vaccine containing diphtheria, tetanus, pertussis or poliovirus
  • Severe allergic reaction (anaphylaxis) to any ingredient in any of Kinrix's vaccines
  • Encephalopathy (declining level of consciousness, coma, seizure) within seven days of receiving any pertussis-containing vaccine
  • Progressive neurologic disorders (spasms, epilepsy)[45]
Pediarix[47]2002[48]DTaP-IPV-HepB vaccine; also immunizes against hepatitis B and poliomyelitis as a three-dose series in infants two, four, and six months (4–8 weeks apart).[47]
  • Severe allergic reaction (anaphylaxis) after a previous dose of Pediarix, any type of ingredient of Pediarix, or any other diphtheria toxoid, tetanus toxoid, pertussis-containing vaccine, inactivated poliovirus vaccine or H. influenzae type b vaccine.
  • Encephalopathy within seven days of pertussis-containing vaccine.
  • Progressive neurologic disorder of spasms, epilepsy until the condition has stabilized.[47]
Pentacel[49]2008[50]DTaP-IPV/Hib vaccine; also immunizes against invasive Haemophilus influenza type b and poliomyelitis. It is a four-dose series given at: 2, 4, and 6 months, and at 15–18 months of age.[49]
  • Severe allergic reaction (anaphylaxis) after a previous dose of Pentacel, any type of ingredient of Pentacel, or any other diphtheria toxoid, tetanus toxoid, pertussis-containing vaccine, inactivated poliovirus vaccine or H. influenzae type b vaccine.
  • Encephalopathy within seven days of pertussis-containing vaccine.
  • Progressive neurologic disorder of spasms, epilepsy until the condition has stabilized.[49]
Quadracel[51]2015[52]DTaP-IPV vaccine; also immunizes against poliomyelitis. It is approved for use as a fifth dose for children aged 4–6 years old in the DTaP vaccination series and as a fourth or fifth dose in the inactivated polio (IPV) series.[51]
  • Severe allergic reaction (anaphylaxis) after a previous dose of Quadracel, any type of ingredient of Quadracel, or any other diphtheria toxoid, tetanus toxoid, pertussis-containing vaccine, inactivated poliovirus vaccine or H. influenzae type b vaccine.
  • Encephalopathy within seven days of pertussis-containing vaccine.
  • Progressive neurologic disorder of spasms, epilepsy until the condition has stabilized.[51]
TDaP Vaccines in the US
Trade name Approval date Comments Contraindications
Adacel[53]2005[54]For use in ages 10 through 64 as an active booster immunization against tetanus, diphtheria, and pertussis. It may also be administered as prophylaxis for wound management.[53] It has not been shown to be safe or effective as a primary immunization or to complete the series.
  • Hypersensitivity reaction (anaphylaxis) after a previous dose of Adacel, any type of ingredient of Adacel, or any other diphtheria toxoid, tetanus toxoid, pertussis-containing vaccine, inactivated poliovirus vaccine or H. influenzae type b vaccine.
  • Encephalopathy (coma, seizure, loss of consciousness) within seven days of pertussis-containing vaccine.
  • Progressive neurologic disorder of spasms, epilepsy until the condition has stabilized.[53]
Boostrix[55]2005[56]For use in ages ten and older as a single intramuscular injection into the deltoid as a booster immunization against tetanus, diphtheria, and pertussis. It may also be administered as prophylaxis for wound management.[55]
  • Hypersensitivity reaction (anaphylaxis) after previously receiving a vaccine containing any form of tetanus toxoid, diphtheria toxoid, or pertussis-containing antigen.
  • Hypersensitivity reaction (anaphylaxis) to any ingredient within a previously administered Boostrix vaccine.
  • Encephalopathy (coma, seizure, loss of consciousness) progression within seven days of receiving a vaccine with antigens from pertussis.[55]

Australia
TDaP Vaccines in Australia
Trade nameApproval dateComments
Adacel[57]2005[58]Adacel is indicated for active immunisation against tetanus, diphtheria and pertussis in persons aged ten years and over as a booster following primary immunisation.[58]
Adacel Polio[59]2006[60]Adacel Polio is indicated for active immunization against diphtheria, tetanus, pertussis and poliomyelitis in adults, adolescents and children aged four years and older as a booster following primary immunization.[60]
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Further reading

Diphtheria

Pertussis

Tetanus
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