diphtheria toxoid/tetanus toxoid (dT, Td)
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Introduction
No longer available[10]
Indications
- active immunity against diphtheria & tetanus
Contraindications
- patients receiving immunosupressive agents
- prior anaphylactic, allergic or systemic reactions
- hypersensitivity to diphtheria or tetanus toxoid
Caution:
- pregnancy is not a contraindication
- waiting until the 2nd trimester is prudent
- patients with a severe local reaction (Arthus-type) should not be given another routine or emergency dose for 10 years
Dosage
- Infants & children (6 weeks to 1 year):
- 3 0.5 mL doses at least 4 weeks apart
- give reinforcing dose 6-12 months after 3rd injection
- Children 1-6 years:
- 2 0.5 mL doses at least 4 weeks apart
- give reinforcing dose 6-12 months after 2nd injection
- if final dose given after 7th birthday, use adult preparation
- Kinrix is combination vaccine for children 4-6 years of age
- Adults & children > 7 years of age:
- primary immunization
- 2 0.5 mL doses at least 4-6 weeks apart
- give reinforcing dose 6-12 months after 2nd injection
- boosters every 10 years
- 0.5 mL SC after penetrating wound if > 5 years since last booster
- primary immunization
- elderly: a single booster after age 49
Injection: (pediatric use):
- diphtheria 6.6-15 Lf units & tetanus 5-10 Lf units/0.5 mL 5 mL vials
Injection: (adult use):
- diphtheria 1.5-2 Lf units & tetanus 5-10 Lf units/0.5 mL 5 mL vials
Pharmacokinetics
elimination: liver
Adverse effects
- common (> 10%)
- fretfulness
- drowsiness
- less common (1-10%)
- uncommon (< 1%)
- transient fever, convulsions (rare), tenderness, swelling, redness, pain, Arthus-type hypersensitivity reaction, tachycardia, hypotension, urticaria, pruritus
Drug interactions
- immunosuppressive agents decreased response to the vaccine
Laboratory
- Corynebacterium diphtheriae IgG in serum
- Clostridium tetani toxoid IgG in serum Clostridium tetani toxoid IgE in serum
Mechanism of action
- stimulates immunity to diphtheria & tetanus by eliciting specific antibodies for bacterial toxins
Notes
- a single dose of Tdap should be given to adults age >= 10 years to replace the next diphtheria-tetanus toxoid dT booster[5]
- TdaP is acceptable alternative to dT[8]
- a regression model estimates without further booster vaccination, 95% of the population would remain protected against tetanus for up to 72 years & against diphtheria for up to 42 years[7]
More general terms
More specific terms
Additional terms
- acellular pertussis vaccine/diphtheria toxoid/poliovirus vaccine inactivated/tetanus toxoid (Quadracel, DTaP-IPV, Kinrix)
- diphtheria
- tetanus
- tetanus toxoid
Component of
Components
References
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 7
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Centers for Disease Control and Prevention (CDC) Recommendations for preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines. http://www.cdc.gov/mmwr/early_release.html
- ↑ 5.0 5.1 Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
- ↑ Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ 7.0 7.1 Hammarlund E et al. Durability of vaccine-induced immunity against tetanus and diphtheria toxins: A cross-sectional analysis. Clin Infect Dis 2016 May 1; 62:1111 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27060790
- ↑ 8.0 8.1 Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H. Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2019. MMWR Morb Mortal Wkly Rep 2020;69:77-83 https://www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm
- ↑ Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H. Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2019. MMWR Morb Mortal Wkly Rep. 2020 Jan 24;69(3):77-83 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31971933 PMCID: PMC7367039 Free PMC article
- ↑ 10.0 10.1 Wodi AP et al. Advisory committee on immunization practices recommended immunization schedule for children and adolescents aged 18 years or younger - United States, 2024. MMWR Morb Mortal Wkly Rep 2024 Jan 11; 73:6 https://www.cdc.gov/mmwr/volumes/73/wr/mm7301a2.htm
American Academy of Pediatrics, Committee on Infectious Diseases. Recommended childhood and adolescent immunization schedule: United States, 2024. Pediatrics 2024 Feb; 153:e2023065044 https://publications.aap.org/pediatrics/article/153/2/e2023065044/195490/Recommended-Childhood-and-Adolescent-Immunization