Diphtheria toxoid booster

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... 

Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) is recommended as a single booster for the following groups in place of a tetanus booster. 

Administer at age 11-12 years for those who have completed the recommended childhood DTP/DTaP vaccination series and have not received a tetanus and diphtheria toxoids vaccine (Td) booster dose. 

Adults with uncertain histories of a complete primary vaccination series with tetanus and diphtheria toxoid-containing vaccines should begin or complete a primary vaccination series. A primary series for adults is 3 doses of tetanus and diphtheria toxoid-containing vaccines administerthe first2 doses at least 4 weeks apart and the third dose 6-12 months after the second. However, Tdap can substitute for any one of the doses of Td in the 3-dose primary series. The booster dose of tetanus and diphtheria toxoid-containing vaocine should be administered to adults who have completed a primary series and if the last vaccination was received >10 years previously. Tdap or Td vaccine may be used, as indicated. 

For nonimmunized adults, a complete three-dose series of diphtheria toxoid should be administered, with the first two doses given at least 4 weeks apart and the third dose given 6 to 12 months after the second. The combined preparation, tetanus-diphtheria, is recommended in adults because it contains less diphtheria toxoid than DTaP, with fewer reactions seen from the diphtheria preparation. Booster doses are given every 10 years. 

The occurrence of epidemic diphtheria in Eastern Europe led to the recommendation in the UK that those aged 15-18 years should receive a combined tetanus and low-dose diphtheria toxoid vaccine instead of a tetanus booster alone. In March 1995, 220 children aged 14—16 years were inadvertently given high-dose diphtheria and tetanus toxoid vaccine, and their parents were sent a questionnaire 153 replied. A total of 141 (92%) of adolescents reported one or more reactions, most of which were classified as mild or moderate and lasted less than 1 week. However, 47 (31%) reported at least one severe local or systemic reaction (2). 

Adult Td consists of tetanus toxoid, 5 LF U/0.5 mL, and diphtheria toxoid, adsorbed 2 LF U/0.5 mL up to 12.5 LF U/0.5 mL. A 0.5-mL dose is given intramuscularly. Adult Td Is used for routine boosters and primary vaccination in persons 7 years old and older. Three doses constitute a primary series of Td. The first two doses are separated by a minimum of 4 weeks, with the third dose given 6-12 months after the second. Boosters are given every 10 years thereafter. 

Tetanus-diphtheria (Td or DT)3 Toxoids Intramuscular Two doses 4-8 weeks apart, and a third dose 6-12 months after the second Every 10 years or a single booster at age 50 1. All adults... 

Bacterial toxins such as diphtheria and tetanus can damage host cells but the isolated toxins can also be immunogenic. However, the induced response may not always be very strong and booster shots are required every 10 years. Adjuvants could improve the response and both diphtheria and tetanus toxoids are more effective when combined with pertussis subunit vaccines, the DPT combination at present used clinically. 

Cholera vaccines are produced by inactive bacteria and are administered subcutaneously, intramuscularly, or intradermally. Cholera vaccines should not be administered intradermally in children less than 5 years of age. The vaccination is particularly indicated for people living in highly endemic areas, as well as laboratory and medical personnel exposed to Vibrio cholerae. Diphtheria tetanus pertussis (DTP) vaccine can be made either as toxoids or inactivated whole bacteria. Hemophillus influenzae vaccine is a bacterial polysaccharide conjugated to proteins and is given as one intramuscular dose. A booster dose is not recommended. This vaccine is given to all children in cases such as plenia and other at-risk condiUons. 

There have been comparisons of the immunogenicity and reactogenicity of different diphtheria vaccines. They have involved single or combined administration of diphtheria and/or tetanus toxoids (SEDA-13, 279) (SEDA-15, 345), booster immunization using Td vaccines including either aluminium hydroxide or calcium phosphate as adjuvant (SEDA-20, 288), or either plain or adsorbed formulations (SEDA-21, 328). 

---