TYPES OF DIPHTHERIA VACCINES -
A)Combined /Mixed Vaccines -
DPT (Diphtheria-Pertussis-Tetanus vaccine) DT (Diphtheria-Tetanus toxoid)
DT (Diphtheria-Tetanus adult type)
B)Single vaccines -
APT (Alum precipitated toxoid )
PTAH (Purified toxoid aluminium hydroxide) PTAP (Purified toxoid aluminium phosphate) TAF (Toxoid-antitoxin floccules)
DPT/DT vaccines should not be frozen
Temperature: 4 to 8 degrees centigrade
At subcentre, the vial should be used within a week
When the vaccine is not in use- It is kept in lower most compartment of refrigerator
During immunization session it can be kept at room temperature
In case of electricity failure it is kept at cool & dark place
AGE OF VACCINATION -
Vaccination should be initiated at 6-8 weeks after birth. SCHEDULE -
For DPT - 3 doses for primary immunization at 4-8 weeks interval between the doses.
For DI- 2 doses are sufficient. Boosters - One at 18-24 months of DPT, second at 4-5 years of DT.
SITE OF ADMINISTRATION -
Anterolateral aspect of thigh. INSTRUCTIONS -
Antiseptic (spirit) is used to clean the site.
Do not rub the site.
Cold compresses can be applied at the site after vaccination, if desired. Do not rub the site. Do not apply warm compress.
Antipyretic (Paracetamol) to be given in case of fever.
Against pertussis - about 80%
Against diphtheria and tetanus - 95%-100%
Fever/mild local reactions (swelling, induration, pain) is common- subsides with 3 days. COMPLICATIONS -
(Primarily these are ascribed to pertussis component - Estimated risk is 1:170,000 doses administered).
Progressive neurological disease
Contraindications to second & successive doses of DPT include
Encephalopathy (within 7 days)
Hyporesponsive or hypotensive (shock like syndrome) episode.
Hyperpyrexia with fever, equal to or greater than 105°F (with 3 days).
Persistent and high pitched crying for more than 3 hours.
dT VACCINE -
For immunizing children over 12 years of age and adults
Contains 2 LF diphtheria toxoid per dose
Doses- 2 doses at interval of 4-6 weeks followed by booster 6-12 months after the second dose
MISCELLANEOUS COMMENTS -
If 1 dose of DPT is given followed by lapses of more than 6 months for second dose-then give 2nd dose at 6 months & 3rd after 4-6 weeks.
Second doses given at appropriate time and time lapse after 2nd dose- Only the third dose needs to be given. [3 If child comes at 1-11/2 years of age having received 2 primary doses, give only one third dose (can be called third primary dose or the booster).
There should be at least an interval of 6 months between the primary immunization and booster dose.
The underweight and malnourished as well as preterms can be given the DPT vaccine as per normal schedule.
BCG, DPT and polio can be administered simultaneously if required.
Children with cerebral palsy can be given DPI vaccine.
If a child suffers from convulsions after first dose of DPT, the successive doses should be DT and not DPT. Convulsions occurring within 3 days with/without fever are considered to be due to DPT.
DPT is not recommended after 6-7 years of age. Only DT is to be given.
If a child comes before 4 years of age, 3 doses of DPI should be given as usual followed by 1 booster after 3 years if child is below 6 years. If the child comes after 6 years, then 2 primary doses of DT and 1 booster need to be given.
Mild febrile conditions and common cold are not a contraindication to administration of DPT.
DPT can be given to a child who has received immunoglobulin in the last 6-8 weeks. Only live vaccination is to be avoided for 8 weeks.
DPT can be safely given to a child receiving long term steroids.
DPT has to be given to a child who has recovered from diphtheria.
Though immunologists recommend 6-8 weeks interval in between primary doses of DPI; national schedule recommends 4 weeks interval to minimize drop out rates and to immunize child as early as possible.
DT and Typhoid vaccine can be administered at different sites at the same sitting but not DPT and typhoid as both the vaccines are liable to produce febrile reactions.