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Diphtheria, tetanus, and pertussis immunization in infants and children 0 through 6 years of age

Author
Jan E Drutz, MD
Section Editors
Teresa K Duryea, MD
Morven S Edwards, MD
Deputy Editor
Mary M Torchia, MD

INTRODUCTION

Childhood and adolescent immunizations are one of the most effective means of preventing serious illness. Diphtheria, tetanus, and pertussis immunization in infants and children zero through six years of age will be discussed here. Diphtheria, tetanus, and pertussis immunization in children 7 through 18 years of age and other childhood immunizations are discussed separately. (See "Diphtheria, tetanus, and pertussis immunization in children 7 through 18 years of age" and "Standard immunizations for children and adolescents".)

BACKGROUND

Diphtheria is an acute respiratory or cutaneous illness caused by Corynebacterium diphtheriae. Respiratory diphtheria has a case fatality rate of 5 to 10 percent; mortality is increased (up to 20 percent) among children younger than five years [1]. (See "Epidemiology and pathophysiology of diphtheria" and "Clinical manifestations, diagnosis, and treatment of diphtheria".)

Tetanus is a nervous system disorder characterized by muscle spasms. It is caused by Clostridium tetani, a toxin-producing anaerobe. Mortality is increased among unvaccinated persons [2]. (See "Tetanus".)

Pertussis, or "whooping cough", is an acute respiratory illness caused by Bordetella pertussis. The case fatality rate for pertussis is approximately 0.2 percent; mortality is increased among infants younger than three months of age. (See "Pertussis infection in adolescents and adults: Clinical manifestations and diagnosis" and "Pertussis infection in infants and children: Clinical features and diagnosis".)

VACCINES

Vaccines for diphtheria, tetanus, and pertussis were introduced into the routine childhood immunization schedule in the United States during the 1940s, with dramatic effects on disease incidence (figure 1A-C) [1-3].

                          

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Literature review current through: Nov 2016. | This topic last updated: Tue Oct 04 00:00:00 GMT+00:00 2016.
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References
Top
  1. Centers for Disease Control and Prevention. Diphtheria. In: Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book: Course Textbook, 13th ed, Hamborsky J, Kroger A, Wolfe S (Eds). Public Health Foundation, Washington, DC 2015. www.cdc.gov/vaccines/pubs/pinkbook/index.html (Accessed on June 03, 2015).
  2. Centers for Disease Control and Prevention. Tetanus. In: Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book: Course Textbook, 13th ed, Hamborsky J, Kroger A, Wolfe S (Eds). Public Health Foundation, Washington, DC 2015. www.cdc.gov/vaccines/pubs/pinkbook/index.html (Accessed on June 03, 2015).
  3. Centers for Disease Control and Prevention. Pertussis. In: Epidemiology and Prevention of Vaccine-Preventable Diseases. The Pink Book: Course Textbook, 13th ed, Hamborsky J, Kroger A, Wolfe S (Eds). Public Health Foundation, Washington, DC 2015. www.cdc.gov/vaccines/pubs/pinkbook/index.html (Accessed on June 03, 2015).
  4. American Academy of Pediatrics. Diphtheria. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.325.
  5. American Academy of Pediatrics. Tetanus (lockjaw). In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW, Brady MT, Jackson MA, Long SS. (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.773.
  6. American Academy of Pediatrics. Pertussis (whooping cough). In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.609.
  7. Centers for Disease Control and Prevention (CDC). Licensure of a diphtheria and tetanus toxoids and acellular pertussis adsorbed, inactivated poliovirus, and haemophilus B conjugate vaccine and guidance for use in infants and children. MMWR Morb Mortal Wkly Rep 2008; 57:1079.
  8. Centers for Disease Control and Prevention (CDC). Licensure of a diphtheria and tetanus toxoids and acellular pertussis adsorbed and inactivated poliovirus vaccine and guidance for use as a booster dose. MMWR Morb Mortal Wkly Rep 2008; 57:1078.
  9. Quadracel prescribing information, 2015. https://www.vaccineshoppe.com/image.cfm?doc_id=12924 (Accessed on August 19, 2015).
  10. Liang J, Wallace G, Mootrey G. Licensure of a Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed and Inactivated Poliovirus Vaccine and Guidance for Use as a Booster Dose. MMWR Morb Mortal Wkly Rep 2015; 64:948.
  11. Pertussis vaccination: use of acellular pertussis vaccines among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1997; 46:1.
  12. Langley JM, Halperin SA, Rubin E, et al. Safety and immunogenicity of 2 mixed primary infant immunization schedules of pentavalent diphtheria, tetanus, acellular pertussis, inactivated poliomyelitis, and Haemophilus influenzae Type B vaccines at 2, 4, and 6 months of age: a randomized controlled trial. Pediatr Infect Dis J 2012; 31:189.
  13. National Center for Immunization and Respiratory Diseases. General recommendations on immunization --- recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2011; 60:1.
  14. Jackson LA, Peterson D, Nelson JC, et al. Vaccination site and risk of local reactions in children 1 through 6 years of age. Pediatrics 2013; 131:283.
  15. Jackson LA, Yu O, Nelson JC, et al. Injection site and risk of medically attended local reactions to acellular pertussis vaccine. Pediatrics 2011; 127:e581.
  16. Zhang L, Prietsch SO, Axelsson I, Halperin SA. Acellular vaccines for preventing whooping cough in children. Cochrane Database Syst Rev 2014; :CD001478.
  17. Fulton TR, Phadke VK, Orenstein WA, et al. Protective Effect of Contemporary Pertussis Vaccines: A Systematic Review and Meta-analysis. Clin Infect Dis 2016; 62:1100.
  18. Sheridan SL, Ware RS, Grimwood K, Lambert SB. Number and order of whole cell pertussis vaccines in infancy and disease protection. JAMA 2012; 308:454.
  19. Klein NP, Bartlett J, Rowhani-Rahbar A, et al. Waning protection after fifth dose of acellular pertussis vaccine in children. N Engl J Med 2012; 367:1012.
  20. Witt MA, Katz PH, Witt DJ. Unexpectedly limited durability of immunity following acellular pertussis vaccination in preadolescents in a North American outbreak. Clin Infect Dis 2012; 54:1730.
  21. Witt MA, Arias L, Katz PH, et al. Reduced risk of pertussis among persons ever vaccinated with whole cell pertussis vaccine compared to recipients of acellular pertussis vaccines in a large US cohort. Clin Infect Dis 2013; 56:1248.
  22. Klein NP, Bartlett J, Fireman B, et al. Comparative effectiveness of acellular versus whole-cell pertussis vaccines in teenagers. Pediatrics 2013; 131:e1716.
  23. Hale S, Quinn HE, Kesson A, et al. Changing Patterns of Pertussis in a Children's Hospital in the Polymerase Chain Reaction Diagnostic Era. J Pediatr 2016; 170:161.
  24. Bettinger JA, Halperin SA, De Serres G, et al. The effect of changing from whole-cell to acellular pertussis vaccine on the epidemiology of hospitalized children with pertussis in Canada. Pediatr Infect Dis J 2007; 26:31.
  25. Guiso N, Njamkepo E, Vié le Sage F, et al. Long-term humoral and cell-mediated immunity after acellular pertussis vaccination compares favourably with whole-cell vaccines 6 years after booster vaccination in the second year of life. Vaccine 2007; 25:1390.
  26. Bisgard KM, Rhodes P, Connelly BL, et al. Pertussis vaccine effectiveness among children 6 to 59 months of age in the United States, 1998-2001. Pediatrics 2005; 116:e285.
  27. Lugauer S, Heininger U, Cherry JD, Stehr K. Long-term clinical effectiveness of an acellular pertussis component vaccine and a whole cell pertussis component vaccine. Eur J Pediatr 2002; 161:142.
  28. Roush SW, Murphy TV, Vaccine-Preventable Disease Table Working Group. Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. JAMA 2007; 298:2155.
  29. Tiwari TS, Baughman AL, Clark TA. First pertussis vaccine dose and prevention of infant mortality. Pediatrics 2015; 135:990.
  30. Forsyth K, Plotkin S, Tan T, Wirsing von König CH. Strategies to decrease pertussis transmission to infants. Pediatrics 2015; 135:e1475.
  31. McGirr A, Fisman DN. Duration of pertussis immunity after DTaP immunization: a meta-analysis. Pediatrics 2015; 135:331.
  32. Breakwell L, Kelso P, Finley C, et al. Pertussis vaccine effectiveness in the setting of pertactin-deficient pertussis. Pediatrics 2016; 137.
  33. Schwartz KL, Kwong JC, Deeks SL, et al. Effectiveness of pertussis vaccination and duration of immunity. CMAJ 2016; 188:E399.
  34. Winter K, Harriman K, Zipprich J, et al. California pertussis epidemic, 2010. J Pediatr 2012; 161:1091.
  35. Misegades LK, Winter K, Harriman K, et al. Association of childhood pertussis with receipt of 5 doses of pertussis vaccine by time since last vaccine dose, California, 2010. JAMA 2012; 308:2126.
  36. Khan FN, Lin M, Hinkle CJ, et al. Case-control study of vaccination history in relation to pertussis risk during an outbreak among school students. Pediatr Infect Dis J 2006; 25:1132.
  37. Moore DM, Mathias RG. Patterns of susceptibility in an outbreak of Bordetella pertussis: evidence from a community-based study. Can J Infect Dis 2002; 13:305.
  38. Centers for Disease Control and Prevention (CDC). Pertussis epidemic--Washington, 2012. MMWR Morb Mortal Wkly Rep 2012; 61:517.
  39. Liko J, Robison SG, Cieslak PR. Priming with whole-cell versus acellular pertussis vaccine. N Engl J Med 2013; 368:581.
  40. Tartof SY, Lewis M, Kenyon C, et al. Waning immunity to pertussis following 5 doses of DTaP. Pediatrics 2013; 131:e1047.
  41. Winter K, Glaser C, Watt J, et al. Pertussis epidemic--California, 2014. MMWR Morb Mortal Wkly Rep 2014; 63:1129.
  42. Cherry JD. Epidemic pertussis in 2012--the resurgence of a vaccine-preventable disease. N Engl J Med 2012; 367:785.
  43. Barlow RS, Reynolds LE, Cieslak PR, Sullivan AD. Vaccinated children and adolescents with pertussis infections experience reduced illness severity and duration, Oregon, 2010-2012. Clin Infect Dis 2014; 58:1523.
  44. DeMaria A Jr. Editorial commentary: Accounting for pertussis. Clin Infect Dis 2012; 54:1736.
  45. Immunization Action Coalition Vaccination. Ask the experts Diptheria, tetanus, pertussis. http://www.immunize.org/askexperts/experts_per.asp (Accessed on August 16, 2011).
  46. Trofa AF, Klein NP, Paul IM, et al. Immunogenicity and safety of an inactivated hepatitis A vaccine when coadministered with Diphtheria-tetanus-acellular pertussis and haemophilus influenzae type B vaccines in children 15 months of age. Pediatr Infect Dis J 2011; 30:e164.
  47. Gasparini R, Tregnaghi M, Keshavan P, et al. Safety and Immunogenicity of a Quadrivalent Meningococcal Conjugate Vaccine and Commonly Administered Vaccines After Coadministration. Pediatr Infect Dis J 2016; 35:81.
  48. Broder KR, Cortese MM, Iskander JK, et al. Preventing tetanus, diphtheria, and pertussis among adolescents: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccines recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2006; 55:1.
  49. BOOSTRIX (tetanus toxoid, reduced diptheria toxoid and acellular pertussis vaccine, adsorbed) prescribing information, 2011. http://us.gsk.com/products/assets/us_boostrix.pdf (Accessed on August 16, 2011).
  50. Goodwin H, Nash M, Gold M, et al. Vaccination of children following a previous hypotonic-hyporesponsive episode. J Paediatr Child Health 1999; 35:549.
  51. Gold MS. Hypotonic-hyporesponsive episodes following pertussis vaccination: a cause for concern? Drug Saf 2002; 25:85.
  52. DuVernoy TS, Braun MM. Hypotonic-hyporesponsive episodes reported to the Vaccine Adverse Event Reporting System (VAERS), 1996-1998. Pediatrics 2000; 106:E52.
  53. Baraff LJ, Shields WD, Beckwith L, et al. Infants and children with convulsions and hypotonic-hyporesponsive episodes following diphtheria-tetanus-pertussis immunization: follow-up evaluation. Pediatrics 1988; 81:789.
  54. Vermeer-de Bondt PE, Labadie J, Rümke HC. Rate of recurrent collapse after vaccination with whole cell pertussis vaccine: follow up study. BMJ 1998; 316:902.
  55. Gold M, Goodwin H, Botham S, et al. Re-vaccination of 421 children with a past history of an adverse vaccine reaction in a special immunisation service. Arch Dis Child 2000; 83:128.
  56. Prevention of hepatitis A through active or passive immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1996; 45:1.
  57. Rantala H, Cherry JD, Shields WD, Uhari M. Epidemiology of Guillain-Barré syndrome in children: relationship of oral polio vaccine administration to occurrence. J Pediatr 1994; 124:220.
  58. McIntosh AM, McMahon J, Dibbens LM, et al. Effects of vaccination on onset and outcome of Dravet syndrome: a retrospective study. Lancet Neurol 2010; 9:592.
  59. American Academy of Pediatrics. Immunization in children with a personal or family history of seizures. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW, Brady MT, Jackson MA, Long SS. (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.89.
  60. Decker MD, Edwards KM, Steinhoff MC, et al. Comparison of 13 acellular pertussis vaccines: adverse reactions. Pediatrics 1995; 96:557.
  61. Rosenthal S, Chen R, Hadler S. The safety of acellular pertussis vaccine vs whole-cell pertussis vaccine. A postmarketing assessment. Arch Pediatr Adolesc Med 1996; 150:457.
  62. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. Vaccine Information Statement DTaP (5/17/07). www.cdc.gov/vaccines/pubs/vis/downloads/vis-dtap.pdf (Accessed on August 16, 2011).
  63. Partridge S, Alvey J, Bernstein H, et al. Safety of a combination diphtheria, tetanus toxoid, acellular pertussis, hepatitis B, and inactivated polio vaccine coadministered with a 7-valent pneumococcal conjugate vaccine and a Haemophilus influenzae type b conjugate vaccine. Vaccine 2007; 25:1806.
  64. Zepp F, Schuind A, Meyer C, et al. Safety and reactogenicity of a novel DTPa-HBV-IPV combined vaccine given along with commercial Hib vaccines in comparison with separate concomitant administration of DTPa, Hib, and OPV vaccines in infants. Pediatrics 2002; 109:e58.
  65. Skowronski DM, Remple VP, Macnabb J, et al. Injection-site reactions to booster doses of acellular pertussis vaccine: rate, severity, and anticipated impact. Pediatrics 2003; 112:e453.
  66. Rowe J, Yerkovich ST, Richmond P, et al. Th2-associated local reactions to the acellular diphtheria-tetanus-pertussis vaccine in 4- to 6-year-old children. Infect Immun 2005; 73:8130.
  67. Liese JG, Stojanov S, Zink TH, et al. Safety and immunogenicity of Biken acellular pertussis vaccine in combination with diphtheria and tetanus toxoid as a fifth dose at four to six years of age. Munich Vaccine Study Group. Pediatr Infect Dis J 2001; 20:981.
  68. Rennels MB, Black S, Woo EJ, et al. Safety of a fifth dose of diphtheria and tetanus toxoid and acellular pertussis vaccine in children experiencing extensive, local reactions to the fourth dose. Pediatr Infect Dis J 2008; 27:464.
  69. Jackson LA, Dunstan M, Starkovich P, et al. Prophylaxis with acetaminophen or ibuprofen for prevention of local reactions to the fifth diphtheria-tetanus toxoids-acellular pertussis vaccination: a randomized, controlled trial. Pediatrics 2006; 117:620.
  70. Rennels MB, Deloria MA, Pichichero ME, et al. Extensive swelling after booster doses of acellular pertussis-tetanus-diphtheria vaccines. Pediatrics 2000; 105:e12.
  71. Huang WT, Gargiullo PM, Broder KR, et al. Lack of association between acellular pertussis vaccine and seizures in early childhood. Pediatrics 2010; 126:263.
  72. Sun Y, Christensen J, Hviid A, et al. Risk of febrile seizures and epilepsy after vaccination with diphtheria, tetanus, acellular pertussis, inactivated poliovirus, and Haemophilus influenzae type B. JAMA 2012; 307:823.
  73. Barlow WE, Davis RL, Glasser JW, et al. The risk of seizures after receipt of whole-cell pertussis or measles, mumps, and rubella vaccine. N Engl J Med 2001; 345:656.
  74. Duffy J, Weintraub E, Hambidge SJ, et al. Febrile Seizure Risk After Vaccination in Children 6 to 23 Months. Pediatrics 2016; 138.
  75. Kawai AT, Martin D, Kulldorff M, et al. Febrile Seizures After 2010-2011 Trivalent Inactivated Influenza Vaccine. Pediatrics 2015; 136:e848.
  76. Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and Control of Seasonal Influenza with Vaccines. MMWR Recomm Rep 2016; 65:1.
  77. Reyes IS, Hsieh DT, Laux LC, Wilfong AA. Alleged cases of vaccine encephalopathy rediagnosed years later as Dravet syndrome. Pediatrics 2011; 128:e699.
  78. Verbeek NE, Jansen FE, Vermeer-de Bondt PE, et al. Etiologies for seizures around the time of vaccination. Pediatrics 2014; 134:658.