TETANUS, DIPHTHERIA, PERTUSSIS (ADACEL)

KEY POINTS

Vaccine Targets,

  1. Age 7 – 64: If previously unvaccinated with Tdap (licensed in 2005).

  2. 65 yrs and older: If having contact with infants less than 1yrs-old

  3. All healthcare professionals

  4. Most travelers will require a booster for these diseases, as it is common for people to not maintain such immunity with boosters (every 10 years) and these diseases are much more prevalent in developing countries where universal vaccination is often not practiced.

  5. With each pregnancy, between the 27th – 36th week.

Diseases:

  1. Tetanus: An often fatal (20%) muscle spasm/paralytic disease caused by the toxin of Clostridium tetani, a bacterium, is not transmitted person-to-person.

    a. Symptoms,

    1. Fever

    2. Headache

    3. Jaw muscle stiffness (lockjaw)

    4. Neck stiffness

    5. Swallowing difficulty

    6. Abdominal muscle spasm/rigidity

    b. Incubation: 3 days – 3 weeks

Diphtheria: An acute bacterial disease caused by Corynebacterium diphtheriae. The illness is fever, sore throat, hoarseness, nasal drainage, and a gray membrane in the throat. It can lead to paralysis, heart failure, and death.

Rare in the U.S, it may be encountered in developing countries (especially Eastern Europe).

Pertussis (“whooping cough”): A highly contagious bacterial respiratory infection usually of infants and children caused by Bordatella pertussis, starting as draining of the upper airways, then progressing to deep, convulsive coughs from bronchitis. It can be fatal. 95% of cases are in developing countries.

Prevalence:

  1. Worldwide, but diphtheria and pertussis are mostly in the Third World. 

Transmission:

  1. Tetanus – Usually originates in contaminated wounds in those not immunized to it.

  2. Diphtheria/Pertussis – Respiratory droplets

Treatment:

  1. Tetanus

    a. Tetanus immune globulin (antibody)

    b. Wound management

  2. Diphtheria- Antibiotics/airway management

  3. Pertussis – Antibiotics/airway management

Prevention:

Killed Vaccines

  1. Tdap(Adacel) = Tetanus, diphtheria, acellular pertussis

  2. Td(Decavac) = Tetanus, diphtheria does not contain pertussis

a. Dose: Single dose, intramuscular, 0.5cc

i. Td: 7 – 64yrs-old

ii. Tdap: 11-64yrs-old

iii.One dose should be lifelong protection.

b. Side-Effects:

i. Local Reactions: Minor redness, swelling, pain at injection site. Extensive swelling of the injected limb precludes further doses.

ii.Systemic Reactions

1. Mild – Fever, decreased appetite, drowsiness, swollen glands, rash, irritability are frequent.

2. Serious (mainly with Tdap) – High fever; crying more than 3H (children); collapse (decreased activity/responsiveness); convulsions (uncommon) with no permanent damage; Guillaine-Barre’ syndrome; brachial neuritis; exaggerated painful swelling from shoulder to elbow 2-8H after injection (Td).

c. Precautions/Contraindications

i. Postpone vaccination with moderate pre-existing illness.

ii. Brain dysfunction within 7 days of pertussis vaccination (with no other cause) precludes further vaccination.

iii. Guillaine – Barre’ syndrome (polyneuritis) within 6 weeks of tetanus vaccine could preclude future vaccination.

iv. Reactions that might preclude any further vaccination with pertussis are,

1. 105°F fever within 48H of vaccination.

2. Collapse or shock – like state within 48H of vaccine.

3. Crying persisting > 3H within 48H of vaccine.

4. Convulsions

5. Vaccine response may be suboptimal in immune compromised persons.

6. Latex allergy

7. No data on harmful effects in pregnancy – should only be used after risk/benefit analysis with a physician. Theses vaccines are not contraindicated with breastfeeding.

d. Targets

i. Age 7 – 64: If previously unvaccinated with Tdap (licensed in 2005)

ii. 65yrs and older: If having contact with infants less than 1yrs-old

iii. All healthcare professionals

iv. Most travelers will require a booster for these diseases, as it is common for people to not maintain immunity with standard immunizations and these diseases are much more prevalent in developing countries where universal vaccination is usually not practiced.

v. With each pregnancy, between the 27th – 36th week

Access the VIS Sheet here

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