DTaP Vaccine

1. Epidemiology
   1. DiphtheriaIncidence
      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: 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
6. Schedule: 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
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 HaemophilusInfluenza B Vaccine
      1. Reduced immunogenicity when mixed acellular Pertussis
   2. References
      1. 1996 N Engl J Med 334:341-55,391-2
      2. 1996 JAMA 275:37