TETANUS, DIPHTHERIA (DECAVAC)

KEY POINTS

  1. Vaccine Targets,

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

    2. 65yrs 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 immunity with their standard immunizations and these diseases are much more prevalent in developing countries where universal vaccination is often not practiced.

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,

i. Fever

ii. Headache

iii. Jaw muscle stiffness (lockjaw)

iv. Neck stiffness

v. Swallowing difficulty

vi. Abdominal muscle spasm/rigidity

b. Incubation: 3 days – 3 weeks

2. 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).

 3. Pertussis (“Whooping Cough”): An 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 mostly in the Third World

Transmission:

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

  2. Diphtheria/Pertussis – Respiratory droplets

Treatment:

  1. Tetanus -Tetanus immune globulin (antibody) injection and wound management

  2. Diphtheria- Antibiotics/airway management

  3. Pertussis – Antibiotics/airways management

Prevention:

1. Vaccines – Tdap(Adacel), Td (Decavac)

a. Killed vaccines:

i. Tdap = Tetanus, diphtheria, acellular pertussis

ii. Td = Tetanus, diphtheria

1. Does not contain pertussis

b. Dose: Single dose, intramuscular, 0.5cc

i. Td: 7 – 64yrs-old

ii. Tdap: 11-64yrs-old

iii. One dose should be lifelong protection.

c. 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 3Hrs (children); collapse (decreased activity/responsiveness); convulsions (uncommon) with no permanent damage; Guillaine-Barre’ syndrome (polyneuritis); brachial neuritis; exaggerated painful swelling from shoulder to elbow 2-8Hrs after injection (Td).

d. 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 48Hrs of vaccination.

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

3. Crying persisting > 3hrs within 48Hrs 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.

a. 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 such immunity with standard immunizations and these diseases are much more prevalent in developing countries where universal vaccination is usually not practiced.

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