Diphtheria immunization

This is an acute, non-invasive infectious disease associated with the upper respiratory tract (Chapter 4). The incubation period is fiom 2 to 5 days although the disease remains communicable for up to 4 weeks. A low molecular weight toxin is produced which affects myocardium, nervous and adrenal tissues. Death results in 3-5% of infected children. Diphtheria immunization protects by stimulating the production of an antitoxin. This antitoxin will protect against the disease but not against infection of the respiratory... 

Supposed neurological adverse effects of diphtheria immunization have been reported, but a causal connection was unclear (11). Of five cases of neurological complications after diphtheria or diphtheria-tetanus immunizations two were classified as vaccine-induced pohomyehtis the other three could be traced back to a hjrperergic reaction to diphtheria toxoids in the cerebral vessels (12). 

Indications Diphtheria immunization Category Vaccine Half-life N/A... 

This diphtheria prophylaxis agent is used in diphtheria immunization. 

Diphtheria, Tetanus, and Pertussis. These vacciaes Hi combiaatioa (DTP) have beea routiaely used for active immunization of Hifants and young children sHice the 1940s. The recommended schedule calls for immunizations at 2, 4, and 6 months of age with boosters at 18 months and 4—5 years of age. SHice 1993 these vacciaes have beea available Hi combination with a vacciae that protects agaiast Haemophilus disease, thus providing protectioa agaiast four bacterial diseases Hi oae preparatioa. A booster immunization with diphtheria and tetanus only is recommended once every 10 years after the fifth dose. 

Diphtheria and tetanus Diphtheria and Immunization against Sfee adverse reactions for See package inserts... 

Diphtheria and Certiva, Active immunization against Sse adverse reactions for Follow package... 

Vaccine diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B (recombinant) and inactivated poliovirus combined Pediarix Active immunization against diphtheria, tetanus, pertussis and all known subtypes of hepatitis B virus, and poliomyelitis immunization Sfee adverse reactions against individual vaccines. Primary immunization series 3 doses of 0.5 mLat 6-to 8-week intervals IM (first dose is 2 months of age, but may be given as early as 6 weeks of age)... 

General interventions, such as increasing the fluids in the diet, allowing for adequate rest, and keeping the atmosphere quiet and nonstimulating, may be beneficial. The primary health care provider may prescribe acetaminophen, every 4 hours, to control these reactions. Local irritation at the injection site may be treated with warm or cool compresses, depending on the patient s preference. A lump may be palpated at the injection site after a diphtheria, pertussis, tetanus (DPT) injection or other immunization. This is not abnormal and will resolve itself within several days to several months. 

Corynebacterium diphtheriae, which is non-sporing, is the causal organism of diphtheria, a disease which has largely been eradicated by immunization (Chapter 16). 

A feature that is common to vaccines, immunosera and human immunoglobulins is the maiked specificity of their actions. Each provides immunity to only one infection. This specificity has led to the development of vaccines and immunosera with several different components such as are present in the widely used diphtheria/tetanus/pertussis vaccines that are used to prevent the infectious diseases that commonly afflict infants and young children. 

The single-component bacterial vaccines are listed in Table 15.1. For each vaccine, notes are provided of the basic material fkm which the vaccine is made, the salient production processes and tests for potency and for safety. The multicomponent vaccines that are made by blending together two or more of the single component vaccines are required to meet the potency and safety requirements for each of the single components that they contain. The best known of the combined bacterial vaccines is the adsorbed diphtheria, tetanus and pertussis vaccine (DTPerWac/Ads) that is used to immunize infants, and the adsorbed diphtheria and tetanus vaccine (DTWac/Ads) that is used to reinforce the immunity of school entrants. 

Administration of preformed anhbodies, taken from animals, flxm pooled human serum, or flom human cell-lines is often used to treat an existing infechon (e.g. tetanus, diphtheria) or condition (venomous snake-bite). Pooled human serum may also be administered prophylachcally, within a slow-release vehicle, for those persons entering parts of the world where diseases such as hepatitis A are endemic. Such administrations confer no long-term immunity and will interfere with conciurent vaccinalion procedures. 

Since these vaecines are imable to evoke a natural infection profile with respeet to the release of antigen they must be administered on a number of occasions. Immunity is not complete until the course of immunization is complete and, with the exeeption of toxin-dominated diseases (diphtheria, tetanus) where the immimogen is a toxoid, will never match the performance of live vaccine delivery. Specificity of the immrme resporrse generated in the patient is initially low. This is particularly the case when the vaeeine is composed of a relatively crude cocktail of killed cells where the immime response is direeted only partly towards antigenic components of the cells that are assoeiated with the infeetion process. This increases the possibility of adverse reaetions in the patient. 

In the early 1900s, a balanced mixture of diphtheria toxin and antitoxin was found to produce active immunity in both animals and humans. This preparation gained widespread acceptance and protected approximately 85% of recipients. Several years later, diphtheria toxoid was developed by treating the toxin with small amounts of formalin. This process caused the toxin to lose its toxic properties while maintaining its immunogenic properties. In the mid-1920s, the addition of an alum precipitate enhanced the immunogenic properties of the toxoid. 

In the 1940s, diphtheria toxoid was combined with tetanus toxoid and whole cell pertussis vaccines, and later with the acellular pertussis vaccine. The diphtheria toxoid, tetanus toxoid, and acellular pertussis vaccine are part of the routine childhood immunization schedule. Diphtheria toxoid is also combined with tetanus toxoid and is commonly used as a booster vaccine. The pediatric product (DT) has a higher amount of diphtheria toxoid than does the adult product (Td). Diphtheria toxoid is not available as an individual vaccine. 

Recent outbreaks of diphtheria have demonstrated that immunity wanes in adulthood. Approximately 50% of all adults no longer have immunity to diphtheria. Regular boosters with tetanus and diphtheria toxoids every 10 years will provide adequate recall immunity to diphtheria provided the adult was previously immunized.2... 

Immunity to tetanus decreases with increasing age, therefore a regular booster every 10 years with tetanus toxoid is recommended. The preferred agent to use in adults is tetanus and diphtheria toxoid (Td) in order to give a booster for diphtheria. Tetanus immunization status should be assessed in the management of wounds in individuals seeking medical care. A tetanus booster should be administered if a tetanus-containing... 

Diphtheria and tetanus toxoids and acellular pertussis (Dtap) vaccine should be administered in a five-shot series to all children beginning at 2 months of age (Table 83-1). The shots are given at 2,4,6, and 15 to 18 months, and 4 to 6 years. Complete immunity to diphtheria and tetanus is achieved after the third vaccination. 

Immunization against diphtheria, tetanus, pertussis and hepatitis B... 

Immunization against H. influenzae type b and hepatitis B Immunization against diphtheria, tetanus, pertussis, hepatitis B, polio and H. influenzae type b Immunization against diphtheria, tetanus and pertussis Immunization against hepatitis B... 

Diphtheria causes a demyelinative neuropathy. Coryne-bacterium diphtheriae colonizes the pharynx or open wounds, and secretes a protein exotoxin. The B subunit of this exotoxin binds to plasma membranes and facilitates entry into cytosol of the A subunit, which catalyzes ADP-ribosylation, and inactivation of an elongation factor required for protein synthesis. Cardiac muscle and Schwann cells are particularly susceptible to this toxin, and hence patients with diphtheria develop cardiomyopathy and demyelinative polyneuropathy [20]. While diphtheria is now uncommon because of childhood immunization against C. diphtheriae, the disruption in preventative medicine programs caused by disintegration of the Soviet Union was followed by a substantial incidence of diphtheritic polyneuropathy in Russia. 

If the immunization history of a patient with anything other than a clean minor wound is not known, tetanus/diphtheria toxoids should be administered. Both tetanus/diphtheria toxoids and tetanus immune globulin should be administered to patients who have never been immunized. 

Two strengths of diphtheria toxoid are available (pediatric [D] and adult, which contains less antigen). Primary immunization with D is indicated for children younger than 6 weeks of age. Generally, D is given along with acellular pertussis and tetanus vaccines (DTaP) at 2, 4, and 6 months of age, and then at 15 to 18 months and 4 to 6 years of age. 

In children, primary immunization against tetanus is usually done in conjunction with diphtheria and pertussis vaccination using DTaP or a combination vaccine that includes hepatitis B and polio vaccines. A 0.5-mL dose is recommended at 2, 4, 6, and 15 to 18 months of age. 

In children 7 years and older and in adults who have not been previously immunized, a series of three 0.5 mL doses of tetanus-diphtheria are administered intramuscularly (IM) initially. The first two doses are given 1 to 2 months apart and the third dose 6 to 12 months later. Boosters are recommended every 10 years. 

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