Tetanus-diphtheria vaccine

In a study of adverse events after immunization in New Zealand in 1990-95 (3), reactions at the injection site after adult tetanus-diphtheria vaccine (68 reports per 100 000 immunizations) were reported five times more often than with tetanus vaccine. 

Van der Wielen M, Van Damme P. Tetanus-diphtheria booster in non-responding tetanus-diphtheria vaccines. Vaccine 2000 19(9-10) 1005-6. 

The elderly suffer most in terms of increased morbidity and mortality when recommended vaccines are not administered. Pneumococcal diseases are the vaccine preventable diseases that cause, by far, the most mortality in the elderly.Unfortunately, the vaccine for pneumococcal-induced pneumonia has one of the lowest administration rates. Other vaccines that most elderly and longterm care residents should receive include the influenza and tetanus/diphtheria vaccines. Consultant pharmacists or pharmacists providing services to long-term care facilities are in excellent positions to identify those who need vaccines. 

In a study of neurodevelopment in infants at 6 months who had been exposed in utero to thimerosal in tetanus-diphtheria vaccines during pregnancy there were no differences from infants who had not been exposed [4Pf. Although there was a significant correlation between the concentration of mercury in the hair of the mothers and the hair of the neonates, there was no correlation between the degree of in utero exposure to ethylmercury and mercury concentrations in neonatal hair. 

Marques RC, D6rea JG, Bernardi JV. Thimerosal exposure (from tetanus-diphtheria vaccine) during pregnancy and neurodevelopment of breastfed infants at 6 months. Acta Paediatr 2010 99(6) 934—9. 

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. 

Adsorption. The adsorption of the components of a vaccine on to a mineral adjuvant. The mineral adjuvants, or carriers, most often used are aluminium lydroxide, aluminium phosphate and calcium phosphate and their effect is to increase the immunogenieity and decrease the toxicity, local and systemic, of a vaccine. Diphtheria vaccine, tetanus vaccine, diphtheria/tetanus vaccine and diphtheriaAetanus/pertussis vaccine are generally prepared as adsorbed vaccines. 

Notes Diphtheria and whooping cough vaccines are seldom used as single-component preparations but as components of diphtheria/tetanus vaccines and diphtheria/tetanus/pertussis vaccines. A combined diphtheria/tetanus/pertussis/Hib vaccine is available. 

Diphtheria and tetanus vaccines are two commonly used toxoid-based vaccine preparations. The initial stages of diphtheria vaccine production entail the growth of Corynebacterium diphtheriae. 

Tetanus, diphtheria, and acellular pertussis (Td/Tdap) vaccination. 

The diphtheria, pertussis, and tetanus (DPT) vaccine, which has prevented more than 95% morbidity from these diseases, has been linked with convulsions, encephalitis, and sudden infant death syndrome. ... 

Examples are diphtheria and tetanus vaccines. Diphtheria vaccine is produced by formaldehyde treatment of the toxin secreted by Corynebacterium diptheriae. Similarly, tetanus vaccine is obtained from toxins of cultured Clostridium tetani that has been treated with formaldehyde. 

Diphtheria and tetanus vaeeine are two eommonly used toxoid-based vaccine preparations. The initial stages of diphtheria vaccine production entails the growth of Corynebacterium diphtheriae. The toxoid is then prepared by treating the active toxin produced with formaldehyde. The product is normally sold as a sterile aqueous preparation. Tetanus vaccine production follows a similar approach Clostridium tetani is cultured in appropriate media, the toxin is recovered and inactivated by formaldehyde treatment. Again, it is usually marketed as a sterile aqueous-based product. 

To some extent the simplest vaccines are those in which the bacterial or viral pathogens has been killed by chemicals or heat so that they themselves cannot cause disease but can confer protection against invasion. This has been used, for example, for the combined diphtheria-tetanus-pertussis vaccine. In this case there were concerns about the presence of entire cells that could cause complications other than the needed protection. Recently acellular systems have been introduced which may... 

In the early 20th century it was recognized that some components of a microbacterial cell were more important than others for protection and thus came the concept of subunit vaccines. When combined with the discovery that bacterial toxins could be inactivated with formaldehyde, the result was the introduction of a diphtheria subunit vaccine in 1923 and a tetanus subunit vaccine in 1927. 

Diphtheria vaccine contains diphtheria toxoid carried on aluminium hydroxide or calcium phosphate. Single antigen products are available only for cases in which combined antigens should not be used. The formulations used in most countries are a childhood formulation containing 25-30 Lf (flocculating units) of diphtheria toxoid (D) and an adult formulation containing 2 Lf of diphtheria toxoid (d). The formulations of choice in routine immunization are DTP (diphtheria and tetanus toxoids combined with pertussis vaccine), DT (diphtheria and tetanus toxoids) for pediatric use, and Td (tetanus and diphtheria toxoids with a limited amount of diphtheria antigen) for use in older children and adults. 

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). 

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). 

Griffith RD, Miller OF 3rd. Erythema multiforme following diphtheria and tetanus toxoid vaccination. J Am Acad Dermatol 1988 19(4) 758-9. 

Lee CY, Thipphawong J, Huang LM, Lee PI, Chiu HH, Lin W, Debois H, Harrison D, Xie F, Barreto L. An evaluation of the safety and immnnogenicity of a five-component acellular pertussis, diphtheria, and tetanus toxoid vaccine (DTaP) when combined with a Haemophilus influenzae type b-tetanus toxoid conjugate vaccine (PRP-T) in Taiwanese infants Pediatrics 1999 103(l) 25-30. 

Sakagnchi M, Nakayama T, Inouye S. Cases of systemic immediate-type nrticaria associated with acellular diphtheria-tetanus-pertussis vaccination. Vaccine 1998 16(11-12) 1138 0. 

Between 1976 and 1985, seven cases of neurological disease were reported to have occurred in Germany among young children after simultaneous administration of oral pohovirus vaccine and diphtheria-tetanus toxoids or diphtheria-tetanus-pertussis vaccine (31). However, the virological data were incomplete only one case was confirmed by the isolation of a vaccine-like polio virus, and in three cases the clinical symptoms did not correspond to poliomyelitis. The author concluded that in some cases the simultaneous administration of injectable vaccines cannot be excluded as a cause for paralysis. 

Burkhard C, Choi M, Wilhelm H. Optikusneuritis als Komplikaton einer Tetanus-Diphtherie-Poliomyelitis-Schutzimpfung ein Fallbericht. [Optic neuritis as a complication in preventive tetanus-diphtheria-poliomyelitis vaccination a case report.] Klin Monatsbl Augenheilkd 2001 218(l) 51-4. 

The reports of the Institute of Medicine, National Academy of Sciences, Washington (on adverse events after pertussis and mbeUa immnnization (SED-12, 817) (SED-12, 825) and on adverse events after immunization against tetanus, diphtheria, measles, mumps, poliomyelitis, H. influenzae type b, and hepatitis B (SEDA-18,325) have provided useful reviews (13,14). The 1996 Update on vaccine side effects, adverse reactions, contraindications,... 

Bakshi R, Graves MC. GuiUain-Barre syndrome after combined tetanus-diphtheria toxoid vaccination. J Neurol Sci 1997 147(2) 201-2. 

Administration of preformed antibodies, taken from animals, from pooled human serum, or from human cell lines is often used to treat an existing infection (e.g. tetanus, diphtheria) or condition (venomous snake bite). Pooled human serum may also be administered prophylactically, 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 concurrent vaccination procedures. 

Gale, J.L. Thapa, P.B. Wassilak, S.G. Bobo, J.K. Men-delman, P.M. Foy, H.M. Risk of serious acute neurological illness after immunization with diphtheria-tetanus-pertussis vaccine. A population-based case-control study. JAMA, J. Am. Med. Assoc. 1994, Jan. 5, 271 (1), 37-41. 

The first group, mainly children with infections, shows persistent IgA and IgM deficiency. It is unusual to see any rise in IgG with infections, this being a useful pointer to its dubious quality. Responses to tetanus, pertussis, and diphtheria vaccines are poor, although some response usually occurs in TAB. Unlike the first case described, most others have shown isohemagglutinins. Lymphocytes have been normal in numbers and in transformation to PHA. The response to dinitrofluorobenzene was normal (D2), but other delayed hypersensitivity reactions have been variable, as has homograft rejection. The lymph nodes have varied from normal through primary follicles with no germinal centers (D2), to absence... 

Appendices 122-1 and 122-2 show the recommended schedules for routine immunization of children and adults. Many states require children to be fuUy immunized prior to entering elementary school however, optimal protection is achieved by immunizing at the recommended ages, which requires special attention to children younger than 2 years of age. Adults and adolescents also require vaccination and often are unaware of this need. Adults should receive routine tetanus-diphtheria boosters and be immune to measles, mumps, rubella, and varicella by either immunization or history of infection. Certain individuals with conditions or lifestyles that put them at high risk for vaccine-preventable diseases also should be immunized as described in the text that follows and outlined in the immunization schedules in the appendices. 

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