| Combination of | |
|---|---|
| Diphtheria vaccine | Vaccine |
| Pertussis vaccine | Vaccine |
| Tetanus vaccine | Vaccine |
| Clinical data | |
| Pregnancy cat. | ? |
| Legal status | ℞ Prescription only |
| Identifiers | |
| ATC code | ? |
| (what is this?) (verify) |
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DPT (also DTP and DTwP) refers to a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis (whooping cough) and tetanus. The vaccine components include diphtheria and tetanus toxoids, and killed whole cells of the organism that causes pertussis (wP).
DTaP and Tdap refer to similar combination vaccines in which the pertussis component is acellular.
Also available is the DT or TD vaccine, which lacks the pertussis component.
In the Netherlands, the acronym DTP refers to a combination vaccine against diphtheria, tetanus, and poliomyelitis. There, pertussis is known as kinkhoest and DKTP refers to a combination vaccine against diphtheria, pertussis/kinkhoest, tetanus, and polio.
The usual course of childhood immunization is five doses between 2 months and 15 years. For adults, separate combination vaccines are used that adjust the relative concentrations of their components.
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While pertussis had been eradicated entirely from the United States, in recent years the disease has made a comeback and resulted in fatalities.[1] At the same time, many parents have declined to vaccinate their children against the disease for fear of side effects;[1] however, most side effects of the vaccination are moderate and severe problems closely following DPT immunization happen very rarely. These include a serious allergic reaction. A study published in the journal Pediatrics in 2009 concluded that the largest risk among unvaccinated children is the disease the vaccination is designed to protect against.[1]
In 1994, the Institute of Medicine of the US National Academy of Sciences published a report stating that if the first symptoms of neurological damage occurred within the first seven days following vaccination with whole-cell pertussis vaccine, the evidence was compatible with the possibility that it could be the cause of permanent brain damage in otherwise apparently healthy children. Since 2002, whole-cell pertussis vaccines are no longer used in the US.
Moderate reactions to DTP vaccines occur in 0.1% to 1.0% of children and include ongoing crying (for three hours or more), a high fever (up to 40 °C / 105 °F), and an unusual, high-pitched crying.
DTaP (also DTPa and TDaP) is a combined vaccine against diphtheria, tetanus, and pertussis, in which the pertussis component is acellular. This is in contrast to whole-cell, inactivated DTP (aka DTwP). The acellular vaccine uses selected antigens of the pertussis pathogen to induce immunity. Because it uses fewer antigens than the whole cell vaccines, it is considered safer, but it is also more expensive. Most of the developed world has switched to DTaP, but developing countries continue to use DTP. Recent research suggests that the DTP vaccine is more effective than DTaP in conferring immunity; this is because DTaP's narrower antigen base is less effective against current pathogen strains.
The acellular vaccine is safer to administer in that it causes substantially fewer side-effects (estimated at 90% fewer), which commonly include local pain and redness, and/or fever.
DTaP was developed in Japan in 1981.
Tdap, sometimes known as dTap,[2] is the acronym for the collective vaccines preventing tetanus, diphtheria, and pertussis in adolescents and adults that were licensed in the United States in spring of 2005. These vaccines differ from the childhood DTaP vaccines (brand name Daptacel) in their indication. As indicated by the lower case "d" and "p", the concentration of diphtheria and pertussis toxoids has been reduced in these "adult" formulations to prevent adverse effects, while the "a" in "ap" indicates that the pertussis toxoids are acellular. Two Tdap vaccines are available in the U.S. Adacel, manufactured by Sanofi Pasteur, is licensed for use in adults ages 11 to 64. Boostrix, manufactured by GlaxoSmithKline, is licensed for use in adolescents and adults ages 10 to 64. The U.S.'s Advisory Committee on Immunization Practices (ACIP) has recommended its use in adults of all ages, including those age 65 and above.[3]
The U.S.'s Advisory Committee on Immunization Practices (ACIP) and Canada's National Advisory Committee on Immunization (NACI) recommended that both adolescents and adults receive Tdap in place of their next Td booster (recommended to be given every 10 years).[4][5][6][7] Tdap can be used as prophylaxis for tetanus in wound management. Five years between doses of Td or doses of Td and Tdap is the current standard of care; frequent exposure to tetanus toxoid can cause local reactions. People who will be in contact with young infants are encouraged to get Tdap even if it has been less than 5 years since Td or TT to reduce the risk of infants being exposed to pertussis. The ACIP statement on Tdap use in adolescents encourages 5 years between Td and Tdap to reduce this risk; however, both suggest that shorter intervals may be appropriate in some circumstances, such as for protection in pertussis outbreaks. NACI suggests intervals shorter than 5 years can be used for catch-up programs and other instances where programmatic concerns make 5-year intervals difficult.
Thimerosal is a preservative sometimes used with certain vaccines. Out of the eight manufactured DPT vaccines, only three ever contained thimerosal. Currently, seven out of the eight DPT vaccines on the market do not use thimerosal, and the product that does (Tripedia) contains trace levels, less than 0.3 micrograms per dose.[8] The World Health Organization has concluded that there is no evidence of toxicity from thimerosal in vaccines.[9]
In August 2006, the non-profit patient safety organization Institute for Safe Medication Practices described medication errors from the confusion between the two different formulations.[10]
There were several mix-ups between DAPTACEL and ADACEL. Daptacel is for active immunization in infants and children 6 weeks to 6 years old. Adacel is indicated for active booster immunization as a single dose in persons 11 to 64 years old and is the first vaccine approved as a pertussis booster for adults. The component antigens in Adacel and Daptacel are the same, but the relative amounts are much greater with the infant vaccination. As such, these are easy to confuse.
In one clinic, 13 adults were vaccinated with Daptacel in error. At another clinic, seven adults received Daptacel instead of Adacel. None of the patients appeared to have experienced any unusual vaccine reactions despite the fact that the pediatric formulation contains greater amounts of the detoxified pertussis toxin and diphtheria toxoid. The similarities of the brand names, generic designations, and vaccine abbreviations (Tdap and DTaP) were felt to have contributed to the confusion.
The World Health Organization recommends a pentavalent vaccine, combining the DTP vaccine with vaccines against Haemophilus influenzae type B and hepatitis B. There is not yet sufficient evidence on how effective this pentavalent vaccine is in relation to the individual vaccines.[11]