Diphtheria&tetanus Toxoid&pertussis Vaccine

From Anvita Health Wiki

Contents 1 Indications 2 Contraindications 3 Dosage 4 Pharmacokinetics 5 Notes 6 More General Terms 7 Additional Terms 8 References

Indications

• active immunization of infants & children 2 months-6 years against diphtheria, tetanus & pertussis [10]
• recommended for primary immunization & routine recall
• acellular pertussis form (INFANRIX) indicated only for children previously immunized 3-4 times with whole cell DPT
• all adults 19-64 who have not previously received TDaP; includng elderly [8,12,13,16]
• pregnant women not previously immunized with Tdap, preferably after 20 weeks' gestation [14]
• adolescents & adults who have not received Tdap & who anticipate close contact with an infant < 12 months of age, preferably 2 weeks before contact with the infant [14]

Contraindications

• patients with cancer
• immunodeficiency
• children with a history of neurologic disorders
• history of serious adverse reactions to pertussis vaccine
• do not use for treatment of diphtheria, tetanus or pertussis infection

• pregnancy-category -
• safety in lactation -

Dosage

• Children 2 months-6 years (2-3 months recommended)

• 0.5 mL IM on 3 occasions at 4-8 week intervals
• reinforcing dose 1 year after 3rd injection
• booster when child is 6 years of age

• along with MMR, required for school entry (2002)

• Adolecents & adults

• Adaacel & Boostrix for adolescents; Adaacel for adults [3,4]
• one time dose with Tdap 0.5 mL IM
• booster vaccination with dT
• wounds, especially puncture wounds: vaccinate with dT

• Tdap + immune globulin if incomplete primary series [11]

• Injection:

• diphtheria 6.7-12.5 Lf units, tetanus 5-12.5 Lf units, & whole cell pertussis 4 protective units/0.5 mL (7.5 mL vials)
• diphtheria 7.5 Lf units, tetanus 5 Lf units, & acellular pertussis 4 protective units/0.5 mL (5 mL vials)

• Tripedia, Infantrix & Daptacel are considered interchangeable

Pharmacokinetics

• elimination: liver Adverse reactions:
• convulsions, screaming episodes, malaise, sleepiness, focal neurologic signs, shock, collapse, chills, erythema, induration, rash, urticaria, local tenderness, arthralgias, fever, swelling, warmth, increased risk of hemophilus b infections in the week following vaccination, allergic or anaphylactic reactions (rare)
• all serious adverse reactions must be reported to the FDA

Notes

• if adverse reaction occurs, immunization should be completed with diphtheria & tetanus toxoid (dT, Td).
• a nodule may be present at the site of injection for a few weeks

More General Terms

• toxoid
• vaccine

Additional Terms

• Bordetella pertussis
• diphtheria
• tetanus

References

1. Kaiser Permanente Northern California Regional Drug Formulary, 1998
2. Prescriber's Letter 12(4): 2005
3. Prescriber's Letter 12(6): 2005 Boostrix Vaccine Detail-Document#: [1] (subscription needed) [2]
4. Ward JI, Cherry JD, Chang SJ, Partridge S, Lee H, Treanor J, Greenberg DP, Keitel W, Barenkamp S, Bernstein DI, Edelman R, Edwards K; APERT Study Group. Efficacy of an acellular pertussis vaccine among adolescents and adults. N Engl J Med. 2005 Oct 13;353(15):1555-63. PMID: [3]
   - Halperin SA. Pertussis--a disease and vaccine for all ages. N Engl J Med. 2005 Oct 13;353(15):1615-7. No abstract available. PMID: [4]
5. Prescriber's Letter 13(2): 2006 Detail-Document#: [5] (subscription needed) [6]
6. Centers for Disease Control and Prevention (CDC) Recommendations for preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines. [7]
7. American Academy of Pediatrics Commitee on Infectious Diseases. Prevention of pertussis among adolescents: recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. Pediatrics. 2006 Mar;117(3):965-78. Epub 2005 Dec 28. PMID: [8] (doi:10.1542/peds.2005-3038) [9]
8. Kretsinger K, Broder KR, Cortese MM, Joyce MP, Ortega-Sanchez I, Lee GM, Tiwari T, Cohn AC, Slade BA, Iskander JK, Mijalski CM, Brown KH, Murphy TV; Centers for Disease Control and Prevention; Advisory Committee on Immunization Practices; Healthcare Infection Control Practices Advisory Committee. Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health- care personnel. MMWR Recomm Rep. 2006 Dec 15;55(RR-17):1-37. Corresponding NGC guideline withdrawn Dec 2011 PMID: [10]
9. Murphy TV, Slade BA, Broder KR, Kretsinger K, Tiwari T, Joyce PM, Iskander JK, Brown K, Moran JS; Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008 May 30;57(RR-4):1-51. Review. PMID: [11]
10. Prescriber's Letter 15(7): 2008 Detail-Document#: [12] (subscription needed) [13]
11. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
12. Steenhuysen J Vaccine panel expands whooping cough coverage Reuters, Oct 27, 2010 [14]
    - Journal Watch, Massachusetts Medical Society Physician's First Watch for October 28, 2010 FirstWatch@jwatch.org
    - Prescriber's Letter 18(2): 2011 Update on Pertussis: Outbreaks and Vaccination Detail-Document#: [15] (subscription needed) [16]
13. FDA NEWS RELEASE: July 8, 2011 FDA approves Boostrix to prevent tetanus, diphtheria, and pertussis in older people [17]
14. Centers for Disease Control and Prevention Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap) in Pregnant Women and Persons Who Have or Anticipate Having Close Contact with an Infant Aged <12 Months --- Advisory Committee on Immunization Practices (ACIP), 2011 MMWR October 21, 2011 / 60(41);1424-1426 [18]
15. Associated Press: February 22 All older adults added to vaccine advice for whooping cough by US advisory panel Washington Post [19]
16. National Guideline Clearinghouse
    - Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants. Recommendations of the Advisory Committee on Immunization Practices (ACIP). ngc-guideline: [20]

diphtheria, tetanus toxoid & pertussis vaccine (DPT, DTaP, TDaP, DTP, Acel-Immune, Tri-Immunol, Tripedia, Daptacel, INFANRIX, Adacel, Boostrix)