DPT vaccine
Encyclopedia
DPT refers to a class of combination vaccine
s against three infectious disease
s in humans: diphtheria
, pertussis
(whooping cough) and tetanus
. The vaccine components include diphtheria and tetanus toxoids, and killed whole cells of the organism that causes pertussis (wP).
DTaP and Tdap refer to similar combination vaccines in which the pertussis component is acellular.
Also available is the DT or TD vaccine, which lacks the pertussis component.
In the Netherlands
, the initialism DTP refers to a combination vaccine against diphtheria, tetanus, and poliomyelitis
. There, pertussis is known as kinkhoest and DKTP refers to a combination vaccine against diphtheria, pertussis/kinkhoest, tetanus, and polio.
The usual course of childhood immunization is five doses between 2 months and 15 years. For adults, separate combination vaccines are used that adjust the relative concentrations of their components.
had been eradicated entirely from the United States, in recent years the disease has made a comeback and resulted in fatalities. At the same time, many parents have declined to vaccinate their children against the disease for fear of side effects; however, most side effects of the vaccination are moderate and severe problems closely following DPT immunization happen very rarely. These include a serious allergic
reaction. A study published in the journal Pediatrics
in 2009 concluded that the largest risk among unvaccinated children is the disease the vaccination is designed to protect against.
In 1994, the Institute of Medicine
of the US National Academy of Sciences published a report stating that if the first symptoms of neurological damage occurred within the first seven days following vaccination with whole-cell pertussis vaccine, the evidence was compatible with the possibility that it could be the cause of permanent brain damage in otherwise apparently healthy children. It continued by stating. DTP vaccination has different pros & cons depending on the nature, place, and surrounding.
Moderate reactions to DTP vaccines occur in 0.1% to 1.0% of children and include ongoing crying
(for three hours or more), a high fever
(up to 40 °C / 105 °F), and an unusual, high-pitched crying.
Since 2002, whole-cell pertussis vaccines are no longer used in the US.
The acellular vaccine is safer to administer in that it causes substantially fewer side-effects (estimated at 90% fewer), which commonly include local pain and redness, and/or fever.
DTaP was developed in Japan in 1981.
, diphtheria
, and pertussis
in adolescents and adults that were licensed in the United States in spring of 2005. These vaccines differ from the childhood DTaP vaccines (brand name Daptacel) in their indication. As indicated by the lower case "d" and "p", the concentration of diphtheria and pertussis toxoids has been reduced in these "adult" formulations to prevent adverse effects
, while the "a" in "ap" indicates that the pertussis toxoids are acellular. Two Tdap vaccines are available in the U.S. Adacel, manufactured by Sanofi Pasteur
, is licensed for use in adults ages 11 to 64. Boostrix, manufactured by GlaxoSmithKline
, is licensed for use in adolescents and adults ages 10 to 64. The U.S.'s Advisory Committee on Immunization Practices
(ACIP) has recommended its use in adults of all ages, including those age 65 and above.
The U.S.'s Advisory Committee on Immunization Practices (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 10 years). Tdap can be used as prophylaxis for tetanus in wound management. Five years between doses of Td or doses of Td and Tdap is the current standard of care; frequent exposure to tetanus toxoid can cause local reactions. People who will be in contact with young infants are encouraged to get Tdap even if it has been less than 5 years since Td or TT to reduce the risk of infants being exposed to pertussis. The ACIP statement on Tdap use in adolescents encourages 5 years between Td and Tdap to reduce this risk; however, both suggest that shorter intervals may be appropriate in some circumstances, such as for protection in pertussis outbreaks. NACI suggests intervals shorter than 5 years can be used for catch-up programs and other instances where programmatic concerns make 5-year intervals difficult.
has concluded that there is no evidence of toxicity from thimerosal in vaccines.
There were several mix-ups between DAPTACEL and ADACEL. Daptacel is for active immunization in infants and children 6 weeks to 6 years old. Adacel is indicated for active booster immunization as a single dose in persons 11 to 64 years old and is the first vaccine approved as a pertussis booster for adults. The component antigens in Adacel and Daptacel are the same, but the relative amounts are much greater with the infant vaccination. As such, these are easy to confuse.
In one clinic, 13 adults were vaccinated with Daptacel in error. At another clinic, seven adults received Daptacel instead of Adacel. None of the patients appeared to have experienced any unusual vaccine reactions despite the fact that the pediatric formulation contains greater amounts of the detoxified pertussis toxin and diphtheria toxoid. The similarities of the brand names, generic designations, and vaccine abbreviations (Tdap and DTaP) were felt to have contributed to the confusion.
The World Health Organization
recommends a pentavalent vaccine, combining the DTP vaccine with vaccines against Haemophilus influenzae type B
and hepatitis B. There is not yet sufficient evidence on how effective this pentavalent vaccine is in relation to the individual vaccines.
Vaccine
A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins...
s against three infectious disease
Infectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...
s in humans: diphtheria
Diphtheria
Diphtheria is an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium. It is characterized by sore throat, low fever, and an adherent membrane on the tonsils, pharynx, and/or nasal cavity...
, pertussis
Pertussis
Pertussis, also known as whooping cough , is a highly contagious bacterial disease caused by Bordetella pertussis. Symptoms are initially mild, and then develop into severe coughing fits, which produce the namesake high-pitched "whoop" sound in infected babies and children when they inhale air...
(whooping cough) and tetanus
Tetanus
Tetanus is a medical condition characterized by a prolonged contraction of skeletal muscle fibers. The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, rod-shaped, obligate anaerobic bacterium Clostridium tetani...
. The vaccine components include diphtheria and tetanus toxoids, and killed whole cells of the organism that causes pertussis (wP).
DTaP and Tdap refer to similar combination vaccines in which the pertussis component is acellular.
Also available is the DT or TD vaccine, which lacks the pertussis component.
In the Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
, the initialism DTP refers to a combination vaccine against diphtheria, tetanus, and poliomyelitis
Poliomyelitis
Poliomyelitis, often called polio or infantile paralysis, is an acute viral infectious disease spread from person to person, primarily via the fecal-oral route...
. There, pertussis is known as kinkhoest and DKTP refers to a combination vaccine against diphtheria, pertussis/kinkhoest, tetanus, and polio.
The usual course of childhood immunization is five doses between 2 months and 15 years. For adults, separate combination vaccines are used that adjust the relative concentrations of their components.
Combination vaccines with whole cell pertussis
While pertussisPertussis
Pertussis, also known as whooping cough , is a highly contagious bacterial disease caused by Bordetella pertussis. Symptoms are initially mild, and then develop into severe coughing fits, which produce the namesake high-pitched "whoop" sound in infected babies and children when they inhale air...
had been eradicated entirely from the United States, in recent years the disease has made a comeback and resulted in fatalities. At the same time, many parents have declined to vaccinate their children against the disease for fear of side effects; however, most side effects of the vaccination are moderate and severe problems closely following DPT immunization happen very rarely. These include a serious allergic
Allergy
An Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
reaction. A study published in the journal Pediatrics
Pediatrics (journal)
Pediatrics is an official peer-reviewed journal of the American Academy of Pediatrics. In the inaugural January 1948 issue, the journal's first editor, Hugh McCulloch, articulated the journal's vision: "The content of the journal is... intended to encompass the needs of the whole child in his...
in 2009 concluded that the largest risk among unvaccinated children is the disease the vaccination is designed to protect against.
In 1994, the Institute of Medicine
Institute of Medicine
The Institute of Medicine is a not-for-profit, non-governmental American organization founded in 1970, under the congressional charter of the National Academy of Sciences...
of the US National Academy of Sciences published a report stating that if the first symptoms of neurological damage occurred within the first seven days following vaccination with whole-cell pertussis vaccine, the evidence was compatible with the possibility that it could be the cause of permanent brain damage in otherwise apparently healthy children. It continued by stating. DTP vaccination has different pros & cons depending on the nature, place, and surrounding.
- This serious acute neurologic response to whole-cell DPT is a rare event. The estimated excess risk ranged from 0 to 10.5 per million immunizations (IOM, 1991). The committee stresses that this is not the strongest statement regarding causality; the evidence does not "establish" or "prove" a causal relation....
- The evidence remains insufficient to indicate the presence or absence of a causal relation between DPT and chronic nervous system dysfunction under any other circumstances. That is, because the NCES is the only systematic study of chronic nervous system dysfunctions after DPT, the committee can only comment on the causal relation between DPT and those chronic nervous system dysfunctions under the conditions studied by the NCES. In particular, the chronic dysfunctions associated with DPT followed a serious acute neurologic illness that occurred in children within 7 days after receiving DPT.
Moderate reactions to DTP vaccines occur in 0.1% to 1.0% of children and include ongoing crying
Crying
Crying is shedding tears as a response to an emotional state in humans. The act of crying has been defined as "a complex secretomotor phenomenon characterized by the shedding of tears from the lacrimal apparatus, without any irritation of the ocular structures"...
(for three hours or more), a high fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
(up to 40 °C / 105 °F), and an unusual, high-pitched crying.
Since 2002, whole-cell pertussis vaccines are no longer used in the US.
DTaP
DTaP (also DTPa and TDaP) is a combined vaccine against diphtheria, tetanus, and pertussis, in which the pertussis component is acellular. This is in contrast to whole-cell, inactivated DTP (aka DTwP). The acellular vaccine uses selected antigens of the pertussis pathogen to induce immunity. Because it uses fewer antigens than the whole cell vaccines, it is considered safer, but it is also more expensive. Most of the developed world has switched to DTaP, but developing countries continue to use DTP. Recent research suggests that the DTP vaccine is more effective than DTaP in conferring immunity; this is because DTaP's narrower antigen base is less effective against current pathogen strains.The acellular vaccine is safer to administer in that it causes substantially fewer side-effects (estimated at 90% fewer), which commonly include local pain and redness, and/or fever.
DTaP was developed in Japan in 1981.
Tdap
Tdap, sometimes known as dTap, is the acronym for the collective vaccines preventing tetanusTetanus
Tetanus is a medical condition characterized by a prolonged contraction of skeletal muscle fibers. The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, rod-shaped, obligate anaerobic bacterium Clostridium tetani...
, diphtheria
Diphtheria
Diphtheria is an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium. It is characterized by sore throat, low fever, and an adherent membrane on the tonsils, pharynx, and/or nasal cavity...
, and pertussis
Pertussis
Pertussis, also known as whooping cough , is a highly contagious bacterial disease caused by Bordetella pertussis. Symptoms are initially mild, and then develop into severe coughing fits, which produce the namesake high-pitched "whoop" sound in infected babies and children when they inhale air...
in adolescents and adults that were licensed in the United States in spring of 2005. These vaccines differ from the childhood DTaP vaccines (brand name Daptacel) in their indication. As indicated by the lower case "d" and "p", the concentration of diphtheria and pertussis toxoids has been reduced in these "adult" formulations to prevent adverse effects
Adverse effect (medicine)
In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...
, while the "a" in "ap" indicates that the pertussis toxoids are acellular. Two Tdap vaccines are available in the U.S. Adacel, manufactured by Sanofi Pasteur
Sanofi pasteur
Sanofi Pasteur is the vaccines division of sanofi-aventis Group. It is the largest company in the world devoted entirely to vaccines.- History :...
, is licensed for use in adults ages 11 to 64. Boostrix, manufactured by GlaxoSmithKline
GlaxoSmithKline
GlaxoSmithKline plc is a global pharmaceutical, biologics, vaccines and consumer healthcare company headquartered in London, United Kingdom...
, is licensed for use in adolescents and adults ages 10 to 64. The U.S.'s Advisory Committee on Immunization Practices
Advisory Committee on Immunization Practices
The Advisory Committee on Immunization Practices provides advice and guidance on effective control of vaccine-preventable diseases in the U.S. civilian population. The ACIP develops written recommendations for routine administration of vaccines to the pediatric and adult populations, along with...
(ACIP) has recommended its use in adults of all ages, including those age 65 and above.
The U.S.'s Advisory Committee on Immunization Practices (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 10 years). Tdap can be used as prophylaxis for tetanus in wound management. Five years between doses of Td or doses of Td and Tdap is the current standard of care; frequent exposure to tetanus toxoid can cause local reactions. People who will be in contact with young infants are encouraged to get Tdap even if it has been less than 5 years since Td or TT to reduce the risk of infants being exposed to pertussis. The ACIP statement on Tdap use in adolescents encourages 5 years between Td and Tdap to reduce this risk; however, both suggest that shorter intervals may be appropriate in some circumstances, such as for protection in pertussis outbreaks. NACI suggests intervals shorter than 5 years can be used for catch-up programs and other instances where programmatic concerns make 5-year intervals difficult.
Thimerosal
Thimerosal is a preservative sometimes used with certain vaccines. Out of the eight manufactured DPT vaccines, only three ever contained thimerosal. Currently, seven out of the eight DPT vaccines on the market do not use thimerosal, and the product that does (Tripedia) contains trace levels, less than 0.3 micrograms per dose. The World Health OrganizationWorld Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
has concluded that there is no evidence of toxicity from thimerosal in vaccines.
Medication errors
In August 2006, the non-profit patient safety organization Institute for Safe Medication Practices described medication errors from the confusion between the two different formulations.There were several mix-ups between DAPTACEL and ADACEL. Daptacel is for active immunization in infants and children 6 weeks to 6 years old. Adacel is indicated for active booster immunization as a single dose in persons 11 to 64 years old and is the first vaccine approved as a pertussis booster for adults. The component antigens in Adacel and Daptacel are the same, but the relative amounts are much greater with the infant vaccination. As such, these are easy to confuse.
In one clinic, 13 adults were vaccinated with Daptacel in error. At another clinic, seven adults received Daptacel instead of Adacel. None of the patients appeared to have experienced any unusual vaccine reactions despite the fact that the pediatric formulation contains greater amounts of the detoxified pertussis toxin and diphtheria toxoid. The similarities of the brand names, generic designations, and vaccine abbreviations (Tdap and DTaP) were felt to have contributed to the confusion.
The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
recommends a pentavalent vaccine, combining the DTP vaccine with vaccines against Haemophilus influenzae type B
Haemophilus influenzae
Haemophilus influenzae, formerly called Pfeiffer's bacillus or Bacillus influenzae, Gram-negative, rod-shaped bacterium first described in 1892 by Richard Pfeiffer during an influenza pandemic. A member of the Pasteurellaceae family, it is generally aerobic, but can grow as a facultative anaerobe. H...
and hepatitis B. There is not yet sufficient evidence on how effective this pentavalent vaccine is in relation to the individual vaccines.