DPT vaccine

DPT vaccine
Combination of
Diphtheria vaccine Vaccine
Pertussis vaccine Vaccine
Tetanus vaccine Vaccine
Legal status
Legal status
  • In general: ℞ (Prescription only)
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DPT (also DTP and DTwP) is 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 bacterium that causes pertussis (wP).

DTaP and Tdap refer to similar combination vaccines in which the component "P" or "p" with lower case "a" is acellular.

Also available are the DT and Td vaccines, which lack the pertussis component.

In the United Kingdom, the Netherlands and France, the abbreviation DTP refers to a combination vaccine against diphtheria, tetanus, and poliomyelitis. In the Netherlands, pertussis is known as kinkhoest and DKTP refers to a combination vaccine against diphtheria, kinkhoest, tetanus, and polio.

The usual course of childhood immunization in the USA is five doses between 2 months and 15 years. For adults, Td boosters are recommended every 10 years.

In the latter 20th century, vaccinations helped to reduce the incidence of childhood pertussis in the United States. Despite this, reported instances of the disease increased twenty-fold in the early 21st century, resulting in numerous fatalities.[1] Over this time, many parents declined to vaccinate their children against pertussis for fear of side effects.[1] In 2009, the journal Pediatrics concluded the largest risk among unvaccinated children was not the contraction of side effects, but rather the disease that the vaccination aims to protect against.[1]

DTP was licensed in 1949.[2]

Combination vaccines with acellular pertussis

DTaP and Tdap are both combined vaccines against diphtheria, tetanus, and pertussis. The difference is in the dosage, with the upper case letters meaning higher quantity.[3]

DTaP

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. 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.[4]

Tdap

Also dTpa, is a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) was licensed in the United States for use in adults and adolescents on June 10, 2005.[5] The lower case "d" and "p" indicated smaller concentrations of diphtheria toxoids and pertussis antigens, and "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. In January 2011, the U.S.'s Advisory Committee on Immunization Practices (ACIP) recommended Tdap's use in adults of all ages, including those age 65 and above. [6] In October 2011, in an effort to reduce the burden of pertussis in infants, the ACIP recommended that unvaccinated pregnant women receive a dose of Tdap. On October 24, 2012, the ACIP voted to recommend use of Tdap during every pregnancy.[7]

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).[8][9][10][11] Tdap and Td can be used as prophylaxis for tetanus in wound management. 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 the risk of side effects; 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.

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 compared to the individual vaccines.[12]

In pregnancy

Guidelines on prenatal care in the United States state that, if an urgent need for tetanus protection occurs during pregnancy, Td vaccine should be administered.[13] If no urgent need arises and the woman has previously received tetanus vaccine, Td vaccination should be delayed until the postpartum period.[13] All postpartum women who have not received Td or Tdap vaccine in the last two years are recommended to receive Tdap prior to discharge after delivery.[13] It is recommended for pregnant women who have never received tetanus vaccine (i.e., have never received DTP, DTaP or DT as child or Td or TT as adult) to receive a series of three Td vaccinations starting during pregnancy to ensure protection against maternal and neonatal tetanus.[13] In such cases, administration of Tdap is recommended after 20 weeks' gestation,[14] and in earlier pregnancy a single dose of Tdap can be substituted for one dose of Td, and then the series completed with Td.[13] The United States Center for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) voted to recommend that health-care personnel should administer a dose of Tdap during each pregnancy at 27 through 36 weeks gestation irrespective of the patient's prior history of receiving Tdap.[15]

Purported non-specific effects

A systematic review was recently completed on this topic so as to compile and rate all of the available evidence.[16] This review showed that receipt of DTP had no significant non-specific effect on all-cause mortality (relative risk 1.38, 0.92 to 2.08). In addition, it showed that many of the studies reporting on this topic were at a high risk of bias.[16] The WHO has recommended that further studies, which are well designed and reflect current vaccine schedules, be carried out on this topic.[17]

DTP vaccine seem to have negative non-specific effects on survival rate of children in high-mortality countries in Africa and Asia[18] The negative effects are seen as long as DTP vaccine is the most recent vaccine. BCG or measles vaccine given after DTP reverses the negative effects of DTP.[18] The negative effects are seen mostly in females.[18]

The negative effects are found in several observational studies. However, six WHO-commissioned studies concluded that there were strong beneficial effects of DTP on overall mortality.[19][20][21][22][23][24] However, controversy ensued as to the design of these studies that had important methodological shortcomings.[25][26] Among others, the WHO-commissioned studies had counted “no information about vaccination” as “unvaccinated”, and they had retrospectively updated vaccine information from surviving children, while no similar update could be made for dead children, creating a so-called “survival bias” which will always produce highly beneficial effect estimates for the most recent vaccine.[27]

References

  1. 1 2 3 "Is Vaccine Refusal Worth The Risk?". NPR. National Public Radio. 2009-05-26. Retrieved 2009-06-19.
  2. ↑ "Vaccine Timeline: Historic Dates and Events Related to Vaccines and Immunization". Immunization Action Coalition. 2013-05-17. Retrieved 2014-06-25.
  3. ↑ "The difference between Tdap and DTaP; dabigatran versus warfarin". JAAPA. Retrieved 2014-06-25.
  4. ↑ Higgs, Higgins, Ross and Mills 2012 'Immunity to the respiratory pathogen Bordatella pertussis' Mucosal Immunol 5(5):485-500
  5. ↑ "Preventing Tetanus, Diphtheria, and Pertussis Among Adults: Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and Recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for Use of Tdap Among Health-Care Personnel". MMWR Morb. Mortal. Wkly. Rep. 55: 1–33. December 15, 2016.
  6. ↑ "Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine from the Advisory Committee on Immunization Practices, 2010". MMWR Morb. Mortal. Wkly. Rep. 60 (1): 13–5. January 2011. PMID 21228763.
  7. ↑ "Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccine (Tdap) in Pregnant Women — Advisory Committee on Immunization Practices (ACIP), 2012". MMWR Morb. Mortal. Wkly. Rep. 62 (7): 131–135. February 22, 2013.
  8. ↑ Broder KR, Cortese MM, Iskander JK, et al. (Mar 2006). "Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines recommendations of the Advisory Committee on Immunization Practices (ACIP)". MMWR Recomm Rep. 55 (RR–3): 1–34. PMID 16557217. , page 18.
  9. ↑ "ACIP Votes to Recommend Use of Combined Tetanus, Diphtheria and Pertussis (Tdap) Vaccine for Adults" (PDF). CDC.gov. Centers for Disease Control and Prevention. Archived from the original (PDF) on 2006-10-19.
  10. ↑ "Interval Between Administration of Vaccines Against Diphtheria, Tetanus, and Pertussis". PHAC-ASPC.GC.ca.
  11. ↑ Kretsinger K, Broder KR, Cortese MM, et al. (December 2006). "Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel". MMWR Recomm Rep. 55 (RR–17): 1–37. PMID 17167397.
  12. ↑ Bar-On ES, Goldberg E, Hellmann S, Leibovici L (2012). "Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae B (HIB)". Cochrane Database Syst Rev. 4 (4): CD005530. doi:10.1002/14651858.CD005530.pub3. PMID 22513932.
  13. 1 2 3 4 5 Health Care Guideline: Routine Prenatal Care. Fourteenth Edition. Archived June 24, 2012, at the Wayback Machine. By the Institute for Clinical Systems Improvement. July 2010.
  14. ↑ Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap) in Pregnant Women and Persons Who Have or Anticipate Having Close Contact with an Infant Aged <12 Months, 2011 - section "Safety of Tdap in Pregnant Women". By the Advisory Committee on Immunization Practices (ACIP), at Centers for Disease Control and Prevention.
  15. ↑ "ACIP provisional updated recommendations on use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) for pregnant women" (PDF). Archived January 23, 2013, at the Wayback Machine.
  16. 1 2 Higgins, Julian P. T.; Soares-Weiser, Karla; López-López, José A.; Kakourou, Artemisia; Chaplin, Katherine; Christensen, Hannah; Martin, Natasha K.; Sterne, Jonathan A. C.; Reingold, Arthur L. (13 October 2016). "Association of BCG, DTP, and measles containing vaccines with childhood mortality: systematic review". BMJ. 355: i5170. doi:10.1136/bmj.i5170. PMC 5063034. PMID 27737834. Retrieved 29 November 2017 – via www.bmj.com.
  17. ↑ "WHO - SAGE meeting of April 2014". www.who.int. Retrieved 29 November 2017.
  18. 1 2 3 Aaby, P; Benn, C; Nielsen, J; Lisse, IM; Rodrigues, A; Ravn, H (22 May 2012). "Testing the hypothesis that diphtheria-tetanus-pertussis vaccine has negative non-specific and sex-differential effects on child survival in high-mortality countries". BMJ Open. 2 (3): e000707. doi:10.1136/bmjopen-2011-000707. PMC 3364456. PMID 22619263.
  19. ↑ Nyarko, P; Pence, B; Debpuur, C (2001). "Immunization status and child survival in rural Ghana". Population council. Working papers no. 147.
  20. ↑ Lehmann, D; Vail, J; Firth, MJ; de Klerk, NH; Alpers, MP (Feb 2005). "Benefits of routine immunizations on childhood survival in Tari, Southern Highlands Province, Papua New Guinea". Int J Epidemiol. 34 (1): 138–48. doi:10.1093/ije/dyh262. PMID 15561755.
  21. ↑ Elguero, E; Simondon, KB; Vaugelade, J; Marra, A; Simondon, F (October 2010). "Non-specific effects of vaccination on child survival? A prospective study in Senegal". Trop Med Int Health. 10 (10): 956–60. doi:10.1111/j.1365-3156.2005.01479.x. PMID 16185229.
  22. ↑ Vaugelade, J; Pinchinat, S; Guiella, G; Elguero, E; Simondon, F (4 December 2004). "Non-specific effects of vaccination on child survival: prospective cohort study in Burkina Faso". BMJ. 329 (7478): 1309. doi:10.1136/bmj.38261.496366.82. PMC 534835. PMID 15550402.
  23. ↑ Moulton, LH; Rahmathullah, L; Halsey, NA; Thulasiraj, RD; Katz, J; Tielsch, JM (October 2005). "Evaluation of non-specific effects of infant immunizations on early infant mortality in a southern Indian population". Trop Med Int Health. 10 (10): 947–55. doi:10.1111/j.1365-3156.2005.01434.x. PMID 16185228.
  24. ↑ Breiman, RF; Streatfield, PK; Phelan, M; Shifa, N; Rashid, M; Yunus, M (December 2004). "Effect of infant immunisation on childhood mortality in rural Bangladesh: analysis of health and demographic surveillance data". Lancet. 364 (9452): 2204–11. doi:10.1016/s0140-6736(04)17593-4. PMID 15610807.
  25. ↑ Aaby, P; Benn, CS; Nielsen, J; Lisse, IM; Rodrigues, A; Jensen, H (Jan 2007). "DTP vaccination and child survival in observational studies with incomplete vaccination data". Trop Med Int Health. 12 (1): 15–24. doi:10.1111/j.1365-3156.2006.01774.x. PMID 17207144.
  26. ↑ Fine, PEM; Smith, PG (2007). "Editorial: 'Non-specific effects of vaccines'- an important analytical insight, and call for a workshop". Trop Med Int Health. 12 (1): 1–4. doi:10.1111/j.1365-3156.2006.01794.x. PMID 17207142.
  27. ↑ Jensen, H; Benn, CS; Lisse, IM; Rodrigues, A; Andersen, PK; Aaby, P (Jan 2007). "Survival bias in observational studies of the impact of routine immunizations on childhood survival". Trop Med Int Health. 12 (1): 5–14. doi:10.1111/j.1365-3156.2006.01773.x. PMID 17207143.
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