A Clinician’s Handbook for Childhood & Adult Immunizations in Georgia
Pathophysiology
Diphtheria
Bacteria
Respiratory transmission
Incubation 2-5 days
Tetanus
Bacteria
Enters the body through a wound
Incubation 3-21 days
Pertussis
Bacteria Respiratory transmission
Incubation 5-10 days
Vaccine Description
Inactivated polysaccharide vaccine, containing diphtheria toxoid, tetanus toxoid & acellular pertussis. This vaccine is licensed for administration only to children 6 weeks through 6 years of age. If child is 7 years of age or older, only Td and Tdap vaccines should be administered. (See Td/Tdap section of this booklet)
Dose & Route
0.5 mL given IM
Dose Recommended Age
1……………….2 months
2……………….4 months
3……………….6 months
4*………………15-18 months (1st booster dose)
5*………………4-6 years (2nd booster dose)
Administration Schedule
*Dose #4 may be administered at 12 months of age if separated by at least 6 months from Dose #3. Dose #4 does not need to be repeated if it has been inadvertently administered ≥4 months after Dose #3.
The #5 Booster Dose is not needed if Dose #4 is given on or after the 4th birthday.
**Guidance for vaccination providers:
The limited supply of Td vaccine needs to be preserved for those with a contraindication to receiving pertussis-containing vaccines. To assist vaccination providers, CDC has developed the following guidance:
- Transition to use of Tdap vaccine in lieu of Td vaccine whenever possible while Td vaccine supplies are constrained.
- Tdap vaccine is an acceptable alternative to Td vaccine, including when a tetanus booster is indicated for wound management.
- Tdap vaccine isn’t an acceptable alternative only when a person has a specific contraindication to pertussis-containing vaccines, which is very rare.
Booster doses:
- *15 – 18 months of age
- *4 – 6 years of age
- 11 – 12 years of age
- Tdap vaccine should be given as a boster at 11-12 years of age. Tdap may be administered regardless of the interval since the last tetanus-and diphtheria-toxoid-containing vaccine. (See Td/Tdap section of this booklet)
- Two diphtheria, tetanus and acellular pertussis vaccines (Tdap) are licensed:
- Boostrix™ for administration to persons 10 years of age and older
- Adacel™ for administration to persons 10-64 years of age
- Every 10 years thereafter for life
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- Td vaccine should be given every 10 years after the administration of Tdap at 11-12 years of age. (See Td/Tdap section of this booklet)
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Minimum Intervals
Dose Minimum Interval
1…………………. 6 weeks of age
2…………………. 4 weeks from dose 1
3…………………. 4 weeks from dose 2
4*………………… No less than 6 months from dose 3
5*………………… No less than 6 months from dose 4
Contraindications
- Use tetanus and diptheria vaccine (Td) of-label for children aged <7 years who develop a contraindication to pertussis-containing vaccine.
- If Td is used, follow the same schedule that would be used for DTaP.
- Children who receive Td in place of DTaP may have sub-optimal protection against diptheria.
Precautions
- Acute, moderate, or severe illness with or without fever. Immunize as soon as illness subsides.
- Temperature of 105 degrees within 48 hours after a previous dose of DTP/DTaP.
- Collapse or shock-like state within 48 hours after receiving a previous dose of DTP/DTaP.
- Persistent, inconsolable crying lasting >3 hours, occurring within 48 hours.
- Convulsions with or without fever occurring within 3 days.