“Diphtheria-tetanus-pertussis” what are these diseases?

Diphtheria (D) is a communicable infectious illness caused by a toxin released by the bacteria, Corynebacterium diphtheriae. It causes a thick covering in the back of the throat leading to breathing problems, paralysis, heart failure, and even death. Even with treatment, about 1 out of 10 people with diphtheria dies.

Tetanus (T) is a life-threatening disease caused by a toxin-releasing bacteria, Clostridium tetani. The toxin causes extremely painful muscle spasms, usually all over the body. It can lead to “locking” of the jaw so you cannot open your mouth or swallow and even breathe. Tetanus kills 1 out of 5 people infected with the disease.

Pertussis (P), also known as ‘whooping cough’, is a respiratory infection caused by a bacteria, Bordetella pertussis. It makes you have uncontrollable, violent coughing. Up to 1 in 20 adults with whooping cough is hospitalized or has complications. Adults may pass on whooping cough to infants, who are at most risk for severe illness, hospitalization, and death.

 

How are these diseases spread?
 

Diphtheria and whooping cough are spread from person to person through coughing or sneezing. Tetanus is not spread from person to person, but enters the body through cuts, scratches, or wounds.

 

How common are these diseases?
 

The bacteria that cause tetanus can be found everywhere in the environment. Nowadays, nearly all cases of tetanus are in people who never got a tetanus vaccine, did not receive a complete course of tetanus vaccine, or ignored booster vaccination.

Diphtheria is no longer common anymore due to widespread vaccination. However, outbreaks still occur around the world and could be a threat to those who are unvaccinated.

Pertussis remains a major health problem among children worldwide. Outbreaks among adolescents and adults have been reported each year. Although in adults the cough won’t last as many days, in infants the symptoms can be even worse. They can come with ‘apnea’ instead of cough and then stop breathing. Many babies who get pertussis are infected by parents, siblings, or caregivers who might not even know they have the disease.

 

What is the diphtheria-tetanus-pertussis vaccine?
 

Diphtheria-tetanus-pertussis vaccine, a 3-in-1 combination vaccine, is an inactive vaccine that consists of pertussis antigens and diphtheria and tetanus toxoids. There are two main types of this vaccine available in Thailand which have different compositions, formulations, and combinations for different age groups:

1. DTaP or DTwP vaccine: This vaccine is used in babies and children <7 years of age. The upper-case letters in these abbreviations mean the vaccine contains full-strength doses of pertussis antigens and diphtheria and tetanus toxoids.
2. Tdap vaccine: This vaccine is used in children > 4 years of age, adolescents and adults. The lower-case “d” and “p” mean the vaccine contains lesser quantities of diphtheria toxoid and pertussis antigen to reduce some side effects.

The “a” in DTaP vaccine and Tdap vaccine stands for “acellular”, meaning that the pertussis component contains only parts of the bacteria instead of the whole bacteria which has fewer side effects.
There is also Td vaccine which can be used in people > 7 years of age. This vaccine protects against only diphtheria and tetanus which is suitable for anyone who should not get the pertussis vaccine.

 

Who should get the diphtheria-tetanus-pertussis vaccine?
 

For infants, doctors give the DTaP or DTwP vaccine in a 4-shot series - at 2 months, 4 months, 6 months, and 18 months. For children, doctors give the DTaP, DTwP, or Tdap vaccine at 4 to 6 years, and again at 11 to 12 years of age with Tdap or Td vaccine. In Thailand, it is a mandatory vaccine included in the childhood immunization program.

But the protection doesn’t last very long. The clinical studies show that the protection against these diseases go down each year after the fifth vaccine dose. Therefore, you should receive the booster shots using the Tdap or Td vaccine through your adulthood.
Receiving the Tdap vaccine as the booster shot is recommended for:

• People aged 11-18 years: Should receive a single dose of Tdap to boost their immunity, preferably at ages 11-12 years.
• People aged 19 years and older: Those who have never received Tdap or especially anyone in close contact with babies less than 12 months of age should get a dose of Tdap.
• Pregnant women: Should get a dose of the Tdap vaccine between 27 and 36 weeks of each pregnancy. Preferably during the early part of the 3rd trimester, but it’s still safe to receive at any point in the pregnancy. By getting Tdap during pregnancy, mothers pass protection to their babies before birth.

 Once you already received this dose, a Tdap or Td booster shot should be given every 10 years, or after 5 years in the case of a severe or dirty wound or burn. Severe cuts or burns raise your risk for tetanus.
The Tdap vaccine can be given at any time of the year. It may be given with other vaccinations.

 

What are the possible side effects of the Tdap vaccine?
 

The Tdap vaccine causes only mild side effects that last up to a few days, such as pain, redness, or swelling in the arm where the shot was given, mild fever, headache, and tiredness. As with any medicines, there is a chance of a vaccine causing a severe allergic reaction, or other serious injuries.


 

References

1. Centers for Disease Control and Prevention. Diphtheria, Tetanus, and Pertussis Vaccine Recommendations [Internet]. 2022 [cited 2022 Sep 9]. Available from: https://www.cdc.gov/vaccines/vpd/dtap-tdap-td/hcp/recommendations.html
2. Centers for Disease Control and Prevention. Diphtheria, Tetanus, and Whooping Cough Vaccination: What Everyone Should Know [Internet]. 2022 [cited 2022 Sep 9]. Available from: https://www.cdc.gov/vaccines/vpd/dtap-tdap-td/public/index.html
3. Centers for Disease Control and Prevention. Pertussis (Whooping Cough) [Internet]. 2022 [cited 2022 Sep 9]. Available from: https://www.cdc.gov/pertussis/about/signs-symptoms.html
4. Centers for Disease Control and Prevention. Tdap (Tetanus, Diphtheria, Pertussis) VIS [Internet]. 2022 [cited 2022 Sep 9]. Available from: https://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.html
5. Centers for Disease Control and Prevention. Tdap/Td vaccines [Internet]. 2022 [cited 2022 Sep 9]. Available from: https://www.cdc.gov/vaccines/hcp/adults/downloads/fs-tdap-hcp.pdf
6. HARVARD HEALTH BLOG. Protection from the TdaP vaccine doesn't last very long [Internet]. 2022 [cited 2022 Sep 9]. Available from: https://www.health.harvard.edu/blog/protection-from-the-tdap-vaccine-doesnt-last-very-long-201602099202
7. Kelli Miller. Tetanus, Diphtheria, Pertussis Vaccine for Adults [Internet]. 2022 [cited 2022 Sep 9]. Available from: https://www.webmd.com/vaccines/tdap-vaccine-for-adults
8. Liang, J., Tiwari, T., Moro, P., Messonnier, N., Reingold, A., Sawyer, M. and Clark, T., 2018. Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. Recommendations and Reports, 67(2), pp.1-44.
9. The Children’s Hospital of Philadelphia. A Look at Each Vaccine: Diphtheria, Tetanus and Pertussis Vaccines [Internet]. 2022 [cited 2022 Sep 9]. Available from: https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-details/diphtheria-tetanus-and-pertussis-vaccines
10. The Immunization Action Coalition (IAC). Diphtheria, Tetanus, Pertussis. [Internet]. 2022 [cited 2022 Sep 9]. Available from: https://www.immunize.org/askexperts/experts_per.asp.