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diphtheria toxoid/tetanus toxoid (dT, Td)

No longer available [10] Indications: - active immunity against diphtheria & tetanus Contraindications: 1) patients receiving immunosupressive agents 2) prior anaphylactic, allergic or systemic reactions 3) hypersensitivity to diphtheria or tetanus toxoid Caution: 1) pregnancy is not a contraindication 2) waiting until the 2nd trimester is prudent 3) patients with a severe local reaction (Arthus-type) should not be given another routine or emergency dose for 10 years pregnancy-category C safety in lactation ? Dosage: 1) Infants & children (6 weeks to 1 year): - 3 0.5 mL doses at least 4 weeks apart - give reinforcing dose 6-12 months after 3rd injection 2) Children 1-6 years: - 2 0.5 mL doses at least 4 weeks apart - give reinforcing dose 6-12 months after 2nd injection - if final dose given after 7th birthday, use adult preparation - Kinrix is combination vaccine for children 4-6 years of age 3) Adults & children > 7 years of age: - primary immunization - 2 0.5 mL doses at least 4-6 weeks apart - give reinforcing dose 6-12 months after 2nd injection - boosters every 10 years - 0.5 mL SC after penetrating wound if > 5 years since last booster 4) elderly: a single booster after age 49 Injection: (pediatric use): - diphtheria 6.6-15 Lf units & tetanus 5-10 Lf units/0.5 mL 5 mL vials Injection: (adult use): - diphtheria 1.5-2 Lf units & tetanus 5-10 Lf units/0.5 mL 5 mL vials Pharmacokinetics: elimination: liver Adverse effects: 1) common (> 10%) - fretfulness - drowsiness 2) less common (1-10%) - anorexia, vomiting, persistent crying 3) uncommon (< 1%) - transient fever, convulsions (rare), tenderness, swelling, redness, pain, Arthus-type hypersensitivity reaction, tachycardia, hypotension, urticaria, pruritus Drug interactions: - immunosuppressive agents decreased response to the vaccine Laboratory: - Corynebacterium diphtheriae IgG in serum - Clostridium tetani toxoid IgG in serum Clostridium tetani toxoid IgE in serum Mechanism of action: - stimulates immunity to diphtheria & tetanus by eliciting specific antibodies for bacterial toxins Notes: - a single dose of Tdap should be given to adults age >= 10 years to replace the next diphtheria-tetanus toxoid dT booster [5] - TdaP is acceptable alternative to dT [8] - a regression model estimates without further booster vaccination, 95% of the population would remain protected against tetanus for up to 72 years & against diphtheria for up to 42 years [7]

Related

acellular pertussis vaccine/diphtheria toxoid/poliovirus vaccine inactivated/tetanus toxoid (Quadracel, DTaP-IPV, Kinrix) diphtheria tetanus tetanus toxoid

Specific

acellular pertussis vaccine/diphtheria toxoid/tetanus toxoid; diphtheria, tetanus toxoid & pertussis vaccine (DPT, DTaP, TDaP, DTP, Acel-Immune, Tri-Immunol, Tripedia, Daptacel, INFANRIX, Adacel, Boostrix)

General

vaccine combination

References

  1. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 7
  3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  4. Centers for Disease Control and Prevention (CDC) Recommendations for preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines. http://www.cdc.gov/mmwr/early_release.html
  5. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
  6. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
  7. Hammarlund E et al. Durability of vaccine-induced immunity against tetanus and diphtheria toxins: A cross-sectional analysis. Clin Infect Dis 2016 May 1; 62:1111 PMID: 27060790
  8. Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H. Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2019. MMWR Morb Mortal Wkly Rep 2020;69:77-83 https://www.cdc.gov/mmwr/volumes/69/wr/mm6903a5.htm
  9. Havers FP, Moro PL, Hunter P, Hariri S, Bernstein H. Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2019. MMWR Morb Mortal Wkly Rep. 2020 Jan 24;69(3):77-83 PMID: 31971933 PMCID: PMC7367039 Free PMC article
  10. Wodi AP et al. Advisory committee on immunization practices recommended immunization schedule for children and adolescents aged 18 years or younger - United States, 2024. MMWR Morb Mortal Wkly Rep 2024 Jan 11; 73:6 https://www.cdc.gov/mmwr/volumes/73/wr/mm7301a2.htm - American Academy of Pediatrics, Committee on Infectious Diseases. Recommended childhood and adolescent immunization schedule: United States, 2024. Pediatrics 2024 Feb; 153:e2023065044 https://publications.aap.org/pediatrics/article/153/2/e2023065044/195490/Recommended-Childhood-and-Adolescent-Immunization

Component-of

acellular pertussis vaccine/diphtheria toxoid/tetanus toxoid; diphtheria, tetanus toxoid & pertussis vaccine (DPT, DTaP, TDaP, DTP, Acel-Immune, Tri-Immunol, Tripedia, Daptacel, INFANRIX, Adacel, Boostrix)

Components

diphtheria toxoid tetanus toxoid