DPT/DT/TT Vaccine:Storage,Schedule,Booster,Efficacy

4th Pediatric Infectious Diseases Conference

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NEWER PERTUSSIS VACCINE

Related topics

Pertussis Vaccine Overview

Tetanus Toxoid(TT)

Dr Nitin Shah
Hon. Pediatrician, UHC, LTMG Hospital, Mumbai.
Treasurer, Indian Academy of Pediatrics, 1998-2001

[DTP = Diphtheria, Pertussis, Tetanus Vaccine (Triple vaccine)]
[DT = Diphtheria, Tetanus Vaccine (Dual vaccine)]
[TT =Tetanus Toxoid Vaccine]

Q. What is DPT given for?
A. DPT is a killed combination vaccine. It contains Diphtheria toxoid, Tetanus toxoid & killed whole cell of Pertussis organism to protect against Diphtheria, Tetanus & Pertussis (whooping cough) respectively.

Q. How are DPT/DT/TT available?
A. DPT/DT/TT are available as ready to use liquid in single dose ampoule containing 0.5 ml of vaccine or as multidose bulb containing 5.0 ml i.e. 10 doses of vaccine.

Q. How are DPT/DT/TT stored?
A. DPT/DT/TT are stored in refrigerator at 2-8⁰ C. They should not be frozen. If frozen by mistake, they should be discarded as on freezing the efficacy goes down & the side effects increase. These vaccines should not be stored in the door compartment.

Q. When is DPT given?
A. 3 primary doses of DPT vaccine are given at 4 weeks interval starting at 6-8 weeks of age along with the 3 primary doses of oral polio vaccine. It is an EPI vaccine recommended by Govt. of India for universal immunization. Hence it is recommended routinely for each and every child.

Q. When are boosters of DPT given?
A. First booster dose of DPT is given at the age of 15-18 months along with the 1st booster dose of OPV. Govt. of India under EPI recommends only DT as the second booster at the age of 4-6 years whereas Indian Academy of Pediatrics recommends DPT and OPV as the 2nd booster at 4-6 years of age.

Q. Why do the recommendations differ from authority to authority regarding 2nd booster dose?
A. Indian Academy of Pediatrics feels that the immunity against pertussis & poliomyelitis will wear off by 5 years as will happen for diphtheria & tetanus. This will lead to increased risk of whooping cough & poliomyelitis in adolescents & adults. In fact pertussis does occur in adolescents & adults, but it may be difficult to suspect & diagnose it at this age. Hence IAP recommends OPV & DPT & not only DT as the 2nd booster at 4-6 years.

Q. How is DPT given?
A. DPT is given as intramuscular injection. It should be given over anterolateral aspect of thigh or over deltoid muscle in older child. It should not be given in the gluteal region especially in <2-year-old child.

Q. Why are intramuscular injections not given over buttocks?
A. Gluteal region is a potentially soiled area. It is difficult to expose especially in an older child. The sciatic nerve can be aberrant & hence can get damaged even when upper outer quadrant rule is followed while injecting. Lastly gluteal region has a lot of fat space. Hence if injection is not given deep, it can enter the fat space leading to poor absorption especially with hepatitis B vaccine. Fat space also has less antigen presenting cells and hence the immune response is suboptimal.

Anterolateral aspect of thigh has good muscle mass. There is not much fat over it. It is a cleaner part & easily exposed. There are no important neurovascular tissues, which can get damaged. Same is true for deltoid muscle which after 6 months can easily take 0.5-1.0 ml of injected volume. This makes the anterolateral aspect of thigh or deltoid muscle the logical choice for any IM injections including vaccines.

Q. What is the efficacy of DPT vaccine?
A. Efficacy of diphtheria toxoid & tetanus toxoid is excellent. The protection is seen in nearly 100% of vaccinees with good long-term protection after primary & booster doses of DPT. The pertussis component is a weak candidate & the protective efficacy is seen in 70-90% of cases. This is one of the reasons why IAP recommends DPT and not only DT as 2nd booster dose at 4-6 years of age.

Next : DPT/DT/TT Vaccine(Contd.)

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