Diphtheria primary prevention
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Overview
The best way to prevent diphtheria is through vaccination. In the United States, there are four vaccines used to prevent diphtheria: DTaP, Tdap, DT, and Td. Each of these vaccines prevents diphtheria and tetanus. The current childhood immunization schedule for diphtheria includes five doses of DTaP for children younger than seven years old. Preteens get a booster dose of Tdap at 11 or 12 years old and teens who did not get Tdap when they were 11 or 12 years old should get a dose the next time they see their doctor. Adults should get a dose of Td every 10 years, according to the adult immunization schedule.[1]
Primary Prevention
The best way to prevent diphtheria is to get vaccinated.[1]
- The current childhood immunization schedule for diphtheria includes five doses of DTaP for children younger than seven years old
- Preteens get a booster dose of Tdap at 11 or 12 years old
- Teens who did not get Tdap when they were 11 or 12 years old should get a dose the next time they see their doctor
- Adults should get a dose of Td every 10 years, according to the adult immunization schedule
Diphtheria vaccines are based on diphtheria toxoid, a modified bacterial toxin that induces protective antitoxin antibodies of the IgG type. Diphtheria toxoid combined with tetanus and pertussis vaccines (DTP) has been part of the WHO Expanded Programme on Immunization (EPI) since its inception in 1974. A reduced dose formulation is generally administered to individuals over 7 years of age. Diphtheria toxoid is one of the safest vaccines available. Individuals with an anti-diphtheria toxin antibody level of more than 0.1 IU/mL are considered fully protected from disease.[2]
Vaccination
In the United States, there are four vaccines used to prevent diphtheria:[3][4]
- DTaP (given to children younger than 7 year)
- Tdap (given to older children and adults)
- DT ( given to children younger than 7 year)
- Td (given to older children and adults)
Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. Lower-case "d" and "p" denote reduced doses of diphtheria and pertussis used in the adolescent and adult formulations. The "a" in DTaP and Tdap stands for "acellular," meaning that the pertussis component contains only parts of the pertussis bacteria instead of the whole cell.
Should not get vaccines or should wait
DTaP Vaccine
- Children should not get DTaP vaccine or should wait if:[4]
- Children who are moderately or severely ill should usually wait until they recover before getting DTaP vaccine (minor illnesses, such as a cold, may be vaccinated)
- 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:
Some of these children should not get another dose of pertussis vaccine, but may get a vaccine without pertussis, called DT.
Td Vaccine
- People should not get this vaccine if:[4]
- A person who has ever had a life-threatening allergic reaction after a previous dose of any tetanus or diphtheria containing vaccine, OR has a severe allergy
- Talk to your doctor if you:
- Had seizures or another nervous system problem
- Had severe pain or swelling after any vaccine containing diphtheria or tetanus
- Ever had a condition called Guillain Barré Syndrome (GBS)
- Not feeling well on the day the shot is scheduled
Tdap Vaccine
- People should not get this vaccine if:[4]
- A person who has ever had a life-threatening allergic reaction after a previous dose of vaccine, OR has a severe allergy to any part of this vaccine
- Anyone who had coma or long repeated seizures within 7 days after a childhood dose of DTP or DTaP, or a previous dose of Tdap (unless a cause other than the vaccine was found)
- Talk to your doctor if you:
- Have seizures or another nervous system problem
- Had severe pain or swelling after any vaccine containing diphtheria, tetanus, or pertussis
- Ever had a condition called Guillain-Barré syndrome (GBS)
- Not feeling well on the day for which the shot is scheduled
Risks of vaccines
Getting diphtheria, 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.
Problems that could happen after any vaccine: People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting, and injuries caused by a fall. Tell your doctor if you feel dizzy, or have vision changes or ringing in the ears. Some people get severe pain in the shoulder and have difficulty moving the arm where a shot was given. This happens very rarely. Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at fewer than 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination. As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.[5]
DTaP Vaccine
Most people who get DTaP vaccine do not have any problems with it.[5]
- 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 or tenderness where the shot was given (up to about 1 child in 4)
- Fussiness (up to about 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 occur more often after the 4th and 5th doses of the DTaP series than after earlier doses. Sometimes the 4th or 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 (up to about 1 child in 30).
- 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 1,000)
- High fever, over 105°F (about 1 child out of 16,000)
- Severe Problems (Very Rare)
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 instructions.
Td Vaccine
Most people who get Td vaccine do not have any problems with it.[5]
- Mild Problems
- Moderate Problems following Td vaccine (do not require medical attention)
- Fever over 102°F (rare)
- Severe Problems following Td vaccine (required medical attention)
- Swelling, severe pain, bleeding and/or redness in the arm where the shot was given (rare)
Tdap Vaccine
Most people who get Tdap vaccine do not have any problems with it.[5]
- Mild problems
- Pain where the shot was given (about 3 in 4 adolescents or 2 in 3 adults)
- Redness or swelling where the shot was given
- Mild fever of at least 100.4°F
- Headache
- Tiredness (about 1 person in 3 or 4)
- Nausea, vomiting, diarrhea, stomach ache
- Chills, sore joints
- Body aches
- Rash, swollen glands (uncommon)
- Moderate problems following Tdap:
- Pain where the shot was given
- Redness or swelling where the shot was given
- Fever over 102°F
- Headache
- Nausea, vomiting, diarrhea, stomach ache
- Swelling of the entire arm where the shot was given
- Pain where the shot was given
- Severe problems following Tdap (required medical attention)
- Swelling, severe pain, bleeding, and redness in the arm where the shot was given (rare)
Recommended Vaccines for Healthcare Workers
Healthcare workers (HCWs) are at risk for exposure to serious, and sometimes deadly, diseases.
- Get a one-time dose of Tdap as soon as possible if healthcare workers (HCWs) have not received Tdap previously (regardless of when previous dose of Td was received)
- Get Td boosters every 10 years thereafter
- Pregnant HCWs need to get a dose of Tdap during each pregnancy
Contacts of cutaneous diphtheria should be treated as described above; however, if the strain is shown to be nontoxigenic, investigation of contacts can be discontinued.
For household contacts
For close contacts, especially household contacts recommensation include:[6]
- A diphtheria toxoid booster, appropriate for age, should be given
- Contacts should also receive antibiotics a 7- to 10-day course of oral erythromycin (40 mg/kg/day for children and 1 g/day for adults)
- Contacts should be closely monitored and antitoxin given at the first sign(s) of illness
For compliance reasons, if surveillance of contacts cannot be maintained, they should receive benzathine penicillin (600,000 units for persons younger than 6 years old and 1,200,000 units for those 6 years and older). Identified carriers in the community should also receive antibiotics.
References
- ↑ 1.0 1.1 Centers for Disease Control and Prevention. Diphtheria Prevention (2016) http://www.cdc.gov/diphtheria/about/prevention.html Accessed on October 9th, 2016
- ↑ world Health Organization. Vaccines. Diphtheria. (2016) http://www.who.int/biologicals/vaccines/diphtheria/en/ Accessed on October 9th, 2016
- ↑ Centers for Disease Control and Prevention. Diphtheria (2016) https://www.cdc.gov/diphtheria/vaccination.html Accessed on October 9th, 2016
- ↑ 4.0 4.1 4.2 4.3 Centers for Disease Control and Prevention. Vaccines and Immunizations (2016) https://www.cdc.gov/vaccines/vpd-vac/should-not-vacc.htm#dtap Accessed on October 9th, 2016
- ↑ 5.0 5.1 5.2 5.3 Centers for Disease Control and Prevention. Diphtheria. Vaccination side effects (2016) https://www.cdc.gov/vaccines/vac-gen/side-effects.htm#dtap Accessed on October 9th, 2016
- ↑ Centers for disease Control and Prevention. Diphtheria. Clinicians http://www.cdc.gov/diphtheria/clinicians.html Accesssed on October 10th, 2016