Infectious Disease Book

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DTaP VaccineAka: DTaP, Diphtheria Tetanus Acellular Pertussis Vaccine, Tdap

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  1. Epidemiology
    1. Diphtheria Incidence
      1. U.S. (1993) No Cases of Diphtheria
      2. Entire Soviet Union (1982) 340 cases
      3. Russia alone (1994) 40,000 cases
    2. Pertussis
      1. Incidence in U.S. reached a low of 1020 cases 1976
      2. Increasing in Incidence in U.S. over last 20 years
      3. Incidence in U.S. 24,000 cases in 2003
        1. Two thirds of cases occur in teens and adults
      4. Adult cases often mild, but infant cases are severe
  2. Indications
    1. Acellular Pertussis vaccine approved for all ages
    2. Should be used in Primary Series
  3. Contraindications to DTP or DTaP administration
    1. Absolute: Severe reaction following prior DTP or DTaP
      1. Immediate Anaphylaxis
      2. Encephalopathy within 7 days of Vaccine
    2. Relative: Moderate Reaction following prior DTP or DTaP
      1. Fever > 40.5 C within 48 hours of vaccine
      2. Seizure within 72 hours of vaccine
      3. Hypotension or Unresponsive Episode within 48 hours
      4. Inconsolable Crying >3 hours within 48 hours
      5. Guillain-Barre Syndrome within 6 weeks of vaccine
    3. Conditions not contraindicating vaccine
      1. Family History of adverse vaccine event
      2. Family History of SIDS
      3. Family of Seizure disorder
      4. Fever following prior vaccine <40.5 C (105 F)
    4. If Vaccine Contraindicated, then
      1. Allergy Testing for anaphylactic reaction
      2. Administer DT to all other groups
  4. Efficacy (after 3 doses)
    1. Cellular vaccine: only 50% effective
    2. Acellular vaccine: 85% effective
  5. Preparations (Use one consistently for Primary Series)
    1. Tripedia
    2. ACEL-IMUNE
    3. Infanrix
    4. New Tdap combinations for boosting Pertussis
      1. Boostrix (approved for adolescents ages 10 to 18)
      2. Adacel (approved for ages 11 to 64 years)
  6. Schedule
    1. Primary Series with DTaP Vaccine
      1. Dose 1: 2 months
      2. Dose 2: 4 months
      3. Dose 3: 6 months
      4. Dose 4: 15 to 18 months (may be given at 12 months)
      5. Dose 5: 4 to 6 years
    2. Maintenance with Tdap for teens
      1. Age 11-12 years: Give Tdap instead of Td
      2. Age 13-18 years: Give Tdap if no Td given yet
        1. Consider Tdap instead of Td
    3. Maintenance for adults
      1. Usual interval between Tdap doses
        1. Tdap Vaccine at 11-12 years, then every 10 years
      2. Indications for shorter interval between Tdap doses
        1. Regular contact with newborns
        2. Consider early booster during local Pertussis epidemic
      3. Minimal interval between doses (usual interval is 10 years)
        1. Last tetanus Immunization was Tdap
          1. General population: Minimum of 5 years from last Tdap dose
          2. Regular contact with newborns: Minimum of 2 years from last Tdap dose
        2. Last tetanus Immunization was Td
          1. No minimum interval between Td and subsequent Tdap
          2. Administer Tdap now to any adult in contact with newborns
  7. Adverse Effects: Acellular vaccine
    1. Marked reduction in adverse effects
    2. Compare with whole cell vaccine
      1. Lower fever
      2. Very low to no Incidence of Seizures or shock state
  8. Adverse Effects: Whole cell vaccine
    1. Mild Reaction to vaccine (75%)
      1. Local ache
      2. Induration
      3. Fever (<39.5)
    2. Moderate
      1. Fever >40.0-40.5
      2. Excess somnolence
      3. Inconsolable crying >4 hours
    3. Severe
      1. Neurologic changes within 3 days of vaccine
      2. Convulsions
      3. Acute encephalopathy
  9. Dosage Protocols
    1. Not compatible with Haemophilus Influenza B Vaccine
      1. Reduced immunogenicity when mixed acellular Pertussis
    2. References
      1. () 1 996 N Engl J Med 334:341
      2. () 1 996 JAMA 275:37

Diphtheria-Tetanus-acellular Pertussis Vaccines (C0535644)

Definition (MSH)Combined vaccines consisting of DIPHTHERIA TOXOID; TETANUS TOXOID; and an acellular form of PERTUSSIS VACCINE. At least five different purified antigens of B. pertussis have been used in various combinations in these vaccines.
ConceptsPharmacologic Substance (T121) , Immunologic Factor (T129)
EnglishDiphtheria Tetanus acellular Pertussis Vaccines, DTaP Vaccine, DTaP Vaccines
CreditsDerived from the NIH UMLS (Unified Medical Language System)


DTaP (C0694728)

Definition (HL7V3.0)diphtheria, tetanus toxoids and acellular pertussis vaccine
ConceptsPharmacologic Substance (T121) , Immunologic Factor (T129)
EnglishDTaP
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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