Most infants and children younger than seven years of age should receive DTaP beginning at two months of age.
Children 7-10 years of age who are incompletely immunized against pertussis should receive Tdap.
11-18 year olds should receive a single dose of Tdap instead of a Td booster if they have completed the recommended childhood DTP/DTaP immunization series and have not received Tdap. The preferred age for Tdap vaccination is 11-12 years. Adults 19-64 years of age should also receive a single dose of Tdap to replace a single dose of Td for booster immunization if their most recent tetanus toxoid-containing vaccine was 10 or more years earlier. Tdap may be given at an interval shorter than 10 years since the last tetanus toxoid-containing vaccine in order to protect against pertussis, especially for:
Women <65 years of age who might become pregnant.
Women who have not previously received Tdap (including those who are breatfeeding) should receive Tdap as soon after birth as is feasible. Many experts also recommend that Tdap be considered for pregnant teenagers.
Adults who have or anticipate having close contact with an infant aged <12 months should receive a single dose of Tdap and trivalent inactivated influenza vaccine. Ideally the vaccines should be given at least 2 weeks before contact.
Health-care personnel who have direct patient contact should receive a single dose of Tdap.
Who should not receive the vaccine?
Those with a history of a serious allergic reaction (such as anaphylaxis) to any of the vaccine components.
Those with a history of encephalopathy (e.g. coma or prolonged seizures) not attributable to an identifiable cause within 7 days of administration of a vaccine with pertussis components.
People with the following conditions should discuss with their health care professional whether they should receive DTaP vaccine:
Moderate or serious reaction after receiving DTP or DTaP in the past
Seizure or have a parent or sibling who has had a seizure
Brain problem that is unstable or getting worse
People who are moderately or severely ill should consult with their physician before receiving any vaccine.
Tetanus
Tetanus (Lockjaw) is caused by toxin-producing spores of a bacterium, Clostridium tetani that inhabit the soil and the bowels of animals and humans. Unlike other vaccine-preventable diseases, it is not spread from person to person. Tetanus infection is most often the result of wound contamination in an unimmunized person or someone who has not had vaccine boosters in many years. Tetanus may occur following delivery in the newborn babies of unimmunized women. It may also occur following puncture wounds, animal bites, burns, abrasions and surgery.
The tetanus toxin causes severe muscle contractions, or spasms. Fever, sweating, elevated blood pressure, and rapid heart rate may also occur. Spasms of the vocal cords or the muscles of respiration can interfere with breathing, and pneumonia is common. Contraction of muscles can be so severe that the spine or other bones are fractured.
Between 40-60 cases of tetanus are reported in the United States each year, and 30% of those infected die. Death is more likely in newborn infants of unimmunized mothers and patients over 50 years of age.
Who Should and Should Not Receive the VaccineTop
Who should receive the vaccine?
Most infants and children younger than seven years of age should receive DTaP beginning at two months of age.
For children who are younger than 7 years of age for whom there is a reason to not give a pertussis-containing vaccine, the TD can be administered.
Children seven to nine years of age who are incompletely immunized, should receive Tdap vaccine. Previously unimmunized children between seven and nine also should receive a dose of Td vaccine one to two months later and then another dose of Td vaccine 6-12 months later.
11-18 year olds should receive a dose of Tdap The preferred age for Tdap vaccination is 11-12 years. Detailed recommendations for the use of Tdap for preteens and adolescents are available from the CDC.
Adults 19-64 years of age should also receive a single dose of Tdap to replace a single dose of Td for booster immunization if their most recent tetanus toxoid-containing vaccine was 10 or more years earlier. Tdap may be given at an interval shorter than 10 years since the last tetanus and diphtheria toxoids-containing vaccine in order to protect against pertussis, especially for:
Women <65 years of age who might become pregnant.
Women who have not previously received Tdap (including those who are breast feeding) should receive Tdap as soon after birth as is feasible. Many experts also recommend that Tdap be considered for pregnant teenagers.
Adults who have or anticipate having close contact with an infant aged <12 months should receive a single dose of Tdap and trivalent inactivated influenza vaccine. Ideally the vaccines should be given at least 2 weeks before contact. Health-care personnel who have direct patient contact should receive a single dose of Tdap.
Td vaccine should be administered every 10 years to provide continued immunity against diphtheria and tetanus and for increased tetanus risk for a tetanus-prone injury if more than 5 years have elapsed since the last dose of a tetanus toxoid-containing vaccine.
Who should not receive the vaccine?
Those with a history of a serious allergic reaction (such as anaphylaxis) to any of the vaccine components.
Those with a history of encephalopathy (e.g. coma or prolonged seizures) not attributable to an identifiable cause within 7 days of administration of a vaccine with pertussis components should not receive a pertussis-containing vaccine.
People with the following conditions should discuss with their health care professional whether they should receive these vaccines:
Moderate or serious reaction after receiving DTP or DTaP in the past
Seizure or have a parent or sibling who has had a seizure (the risk of fever and seizure is much less with the new DTaP vaccines than with DTP).
Brain problem that is unstable or getting worse
People who are moderately or severely ill should consult with their physician before receiving any vaccine.
Diphtheria
Diphtheria is a serious disease that can cause death through airway obstruction, heart failure, paralysis of the muscles used for swallowing and pneumonia. It is caused by the bacterium Corynebacterium diphtheriae, which produces toxins that cause cell death both at the site of infection and elsewhere in the body.
Diphtheria usually begins with a sore throat, slight fever, and swollen neck. Most commonly, bacteria multiply in the throat, where a grayish membrane forms. This membrane can choke the person. Sometimes, the membrane forms in the nose, on the skin, or other parts of the body. The bacteria can release a toxin that spreads through the bloodstream and may cause muscle paralysis, heart and kidney failure, and death. Approximately 5% of people who develop diphtheria (500 out of every 10,000) die from the disease and many more suffer permanent damage.
In the 1920s, before the diphtheria vaccine, there were 100,000 to 200,000 reported cases in the United States each year. Because of the high level of immunization, only about one case of diphtheria occurs each year in the United States. However, in areas where the immunization rate has recently fallen (such as Eastern Europe and the Russian Federation), tens of thousands of people are suffering from diphtheria. The bacterium is still here?even though we do not see many cases. Our children are protected by being immunized and by everyone else being immunized too.
The diphtheria toxoid (inactivated toxin) vaccine offers the greatest protection against this disease. The fully immunized person who is exposed can become a carrier of the bacterium but may only develop a mild case, or may not get sick at all. But if not fully vaccinated, the risk of getting severely ill is 30 times higher.
