diphtheria, pertussis and tetanus vaccination

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Diphtheria, pertussis and tetanus was the original triple vaccine used in the childhood immunisation schedule in the UK at 2,3 and 4 months of age. The vaccine became a quadruple vaccine with the addition of Haemophilus influenzae type B (HiB) and now has five components with addition of inactivated polio vaccine (in the UK, the use or oral polio vaccine has been replaced by use of inactivated polio vaccine (1)):

  • combined vaccine - diphtheria, tetanus, acelular pertussis, inactivated polio, haemophilus inflenzae type B and Hepatitis B (DTaP/IPV/Hib/Hep B)
    • administered at two, three and four months old as part of the childhood immunisation schedule

  • combined vaccine - diphtheria, tetanus, acelular pertussis, inactivated polio vaccine (dTaP/IPV)
    • administered as part of the pre-school booster

  • diphtheria, tetanus and inactivated polio vaccine (Td/IPV)
    • recommended for boosting teenagers aged 13 to 18 years old
    • can also be used for primary immunisation in unvaccinated individuals aged 10 years and over
    • in consideration of travel vaccination - where tetanus, diphtheria or polio protection is required and the final dose of the relevant antigen was received more than ten years ago, Td/IPV should be given (2)

Check uptodate details in the The Green Book before prescribing/administering a vaccine.

Check the Summary of Product Characteristics (SPC) before prescribing/administering a vaccine.

Notes:

  • Td/IPV vaccine should be used where protection is required against tetanus, or diphtheria or polio in order to provide comprehensive long-term protection against all three diseases (2)
  • Tetanus/diphtheria (Td) vaccine may still be available but is not recommended because it does not give protection against poliomyelitis (2)
  • booster doses of vaccines containing acellular pertussis are associated with an increased risk of injection site reactions, compared to primary vaccination (3)
    • some of these affect the entire limb, and may involve blistering around the site of swelling. Such reactions usually develop within 24 hours of vaccination and recover without sequelae within ~5 days
      • risk appears to be dependent on the number of prior doses of DTaP vaccine, with a greater risk following the 4th and 5th doses, although such reactions to a DTaP booster may also occur in children who have been primed with one or more doses of a DTwP vaccine
      • such reactions do not contraindicate further doses of DT or DTaP vaccine
      • if a child presents with signs of extensive limb swelling following d/DTaP-IPV pre-school vaccination it is important to carefully consider whether this may be a recognised injection site reaction. In the absence of clinical or laboratory signs of infection, antibiotics may be ineffective and unnecessary

Reference:

  1. Department of Health (August 10th 2004). New vaccinations for the childhood immunisation programme. PL/CMO/2004/3, PL/CNO/2004/2, PL/CPHO/2004/3.
  2. Department of Health (August 2004). Poliomyelitis - Green Book Update.
  3. Current Problems in Pharmacovigilance (2006);31:1-12.
  4. https://www.nhs.uk/conditions/vaccinations/6-in-1-infant-vaccine/ (Accessed 26/4/19)

Last edited 04/2019

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