Diphtheria Vaccination

Vaccination schedule

Diphtheria remains a serious disease throughout much of the world. In particular, large outbreaks of Diphtheria are currently occurring throughout the New Independent States of the former Soviet Union. Most cases occur in non-immunised or inadequately immunized persons.

Diphtheria immunisation is administered by injecting Diphtheria toxoid, usually in conjunction with Tetanus and Pertussis vaccines (DTP, Td). For primary vaccination, children should receive the vaccine at 2, 4 and 6 months of age. Booster doses for diphtheria are also given at 18 months, 6 years and 12 years. For persons beyond 7 years old, Diphtheria should be given in reduced concentration.

For primary immunisation of persons above 7 years of age, three doses of the formulation of Tetanus-Diphtheria toxoid (Td) is used. The first two doses are given 4 to 8 weeks apart and the third dose 6 to 12 months after the second. A Td booster should be given whenever 10 or more years have elapsed since completion of a primary series or the last booster dose.

Recommendations

Primary or booster doses are recommended for travellers to areas with risk. For those who are frequently travelling to such areas, a ten-yearly booster dose is recommended.

Adverse reactions

DTP frequently causes mild side effects such as slight fever, soreness and tenderness of the injection site for a few days. Most of the side effects occur because of the Pertussis component of the vaccine. In less than 1% of the injections, DTP may cause the following complications: high fever (more than 40.5°C.) or high-pitched cry. In about 1 in 1750 immunisations, DTP can cause the following complications: convulsions, febrile seizure in children, shock or even collapse. Brain damage is rarely reported after DTP injection.

Contraindications

If the child is sick with something more than a mild cold, DTP may be delayed until the child is getting better. If the child has ever had a convulsion, other brain disorder, mal-development after birth, the DTP should be withheld until it is clear that the condition is not worsening or seizures are under control.

If the child has developed the following complications after an initial DTP vaccination, further immunisation may need to be delayed or forsaken:

• seizures within 3 to 7 days after injection;
  
  
• any serious brain problem within 7 days after injection;
  
  
• worsening of seizures or other brain problem;
  
  
• allergy a few hours after injection (symptoms: mouth, throat or face swelling, or breathing difficulty);
  
  
• high fever 2 days after injection;
  
  
• shock or collapse within 2 days after injection;
  
  
• persistent, uncontrolled crying that last for more than 3 hours at a time within 2 days after injection.