DPT/DT/TT Vaccine:Side Effects,Contraindications,Side Effects Treatment

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

Immunization and Vaccination

DPT Vaccine

Immunization and Vaccination

BCG Vaccine

Chickenpox or Varicella Vaccine

DPT Vaccine

Frequently asked questions on immunization

Hepatitis A Vaccine

Hepatitis B Vaccine

Hib Vaccine

Human Papillomavirus vaccine

Immunization Schedule

Influenza vaccine

Measles Vaccine

Meningococcal vaccine

Polio Vaccine

VACCINE REMINDER

Get the Vaccine Schedule for your child."

Today's Poll

Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?

No, it should be used only after drug sensitivity report

Yes, under guidance of an infectious disease expert

Vote

Results

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 are the side effects of DPT/DT/TT?
A. The side effects seen following DPT/DT/TT include local side effects and systemic side effects. Pertussis component of DPT also leads to some serious toxicity as discussed in next question.

Local side effects: It includes pain, swelling, redness & difficulty in walking. It is seen in 30-40% of vaccinees. It persists for 24-72 hours & responds to paracetamol. Rarely if the injection has gone into deep fascia there could be swelling & redness of lateral aspect of thigh. Sometimes a nodule forms at the injection site which may persist for several days to weeks. It may soften and form a sterile abscess. It does not merit any treatment except analgesics. If it shows fluctuation, it can be drained.

Systemic side effects: It includes fever, lassitude, anorexia, vomiting, irritability, excessive crying etc. seen in 30 - 40 % of patients. Fever is usually mild to moderate, lasts for 2-3 days & responds to paracetamol

Q. What are the severe adverse effects of DPT?
A. Pertussis component of DPT is responsible for severe systemic reactions. It is more common with whole cell pertussis containing DPT (DPwT) than acellular pertussis containing DPT (DPaT). It is not seen with DT or TT. It includes hyperpyrexia i.e. fever more than 105⁰ F, excessive crying & screaming spells lasting for more than 4 hours, convulsion occurring within next 7 days, encephalitis in next 14 days, unconsciousness or altered sensorium, hypotonic, hyporeflexic episode (HHE), shock etc. If a patient develops any of those adverse reactions it is a contraindication to further use of DPT & instead only DT should be used. Such reactions should be immediately reported to doctor.

Q. What are the contraindications to use DPT?
A. Primary contraindication (i.e. to the first dose of DPT) is presence of progressive neurological disease like the primary metabolic disorder that affects brain. This of course is rare in clinical practice. Static brain lesions like cerebral palsy, febrile seizures, epilepsy etc are not a contraindication to use of DPT. In patients with epilepsy it is better to control convulsion with drugs so that blame should not go to DPT should a convulsion occur. In febrile seizures patients should be told about fever prophylaxis.

Secondary contraindication (i.e. to further doses) of DPT includes development of severe adverse reactions as discussed above following previous DPT injection.

History of severe adverse reactions to DPT in a child by itself is not a contraindication to its use in siblings.

Q. What is the treatment of side effects following DPT?
A. Paracetamol or ibuprofen can be used to treat pain, swelling, redness, difficulty in walking and fever. It takes 2-3 days for the symptoms to disappear. In case abscess has formed, treat with antibiotics and drainage. Persistent nodule should be left alone, as it does not lead to any other symptoms. Patients developing severe adverse reactions should be admitted & kept for observation & treated symptomatically.

Q. What if the patient comes late for vaccination?
A. Tetanus can occur at any age. Diphtheria usually occurs in first 10 years of life. Pertussis usually occurs in 1st five years of life. Hence if a patient comes late he should still be given 3 doses of DPT if he is less than 5 years, 3 doses of DT if he is 5-10 years & only TT if he is >10 years old. He would also receive a booster of DPT 1 year after the 3rd primary dose & 2nd booster 3-4 years after the 1st booster if he is still <5 years young. He will receive DT as booster if he is 5-10 years old.

Q. What if subsequent dose is delayed?
A. As DPT/DT/TT induce T cell memory response it is not necessary to restart the schedule. It is enough to just complete the age appropriate remaining doses.

Q. Can DPT be given along with other vaccines?
A. DPT can be given along with any other vaccines. In fact it is given along with OPV, Hepatitis B & Hib vaccine. A combination vaccine containing DPT + Hib and DPT + Hepatitis B are available. Other combinations available abroad include IPV + DPT + Hib, DPaT + Hib and IPV+ DPT + Hib + Hepatitis B.

Q. What is acellular pertussis DPT vaccine?
A. As seen before, the severe adverse side effects seen with DPT are due to pertussis component. In fact some countries like UK reverted to only DT in past due to the fear of side effects. This strategy led to widespread epidemics of pertussis, which had severe morbidity & even mortality especially in infancy. Hence it is clear that pertussis vaccine is required to be given routinely. The question is can the side effects be decreased by modifying pertussis vaccine. It was realized that the reactions were due to components of cell wall of pertussis organism, which are not required for efficacy of vaccine. So people tried using only the antigens of pertussis organism like the pertussis toxin filamental antigen, FHA, 69 KD protein etc. All of them proved as immunogenic as whole cell DPT with remarkably lesser side effects. This vaccine is called acellular pertussis vaccine, as it does not have whole cell wall of pertussis. Acellular pertussis DPT is available abroad & is routinely used for both primary doses and for boosters. It will be soon available in India for use as boosters.

Q. What about DT? When is it used?
A. DT has same amount of diphtheria toxoid & tetanus as DPT but does not have pertussis component. It is also called as dual vaccine. The availability, storage, efficacy, method & route of administration are same as DPT. Side effects are similar to DPT. It is given as 2nd booster at 4-5 years under EPI. (IAP recommends DPT as 2nd booster). It is also used in patients where pertussis component is contraindicated.

Q. What is dT vaccine?
A. dT vaccine has 1/10th dose of diphtheria toxoid than present in DT/DPT. If full dose of diphtheria toxoid is given as present in DT/ DPT in children above 10 years of age, it can lead to serious side effects like cardiac toxicity, serum sickness like reactions etc. With lack of natural boosting due to mass vaccination, diphtheria can occur beyond 10-15 years of age in vaccinees. One needs to give booster of diphtheria at 10 years and maybe every 10 years thereafter to maintain protective titres. dT is useful in such cases as a booster at 10 years (instead of TT). It is not yet recommended in India and is neither available.

Next : Tetanus Toxoid(TT)

Mail To Your Friend

Print This Article

Diseases & Conditions

Pediatric Oncall Journal

Case Reports

Original Research

Letter to Editor