Diphtheria/Tetanus Toxoids/Acellular Pertussis Vaccine (DTaP)

  Action Diphtheria and tetanus toxoids induce antibodies against toxins made by Corynebacterium diphtheriae and Clostridium tetani. Pertussis vaccine protects against Bordetella pertussis.

  Indications Active immunization against diphtheria, tetanus, and pertussis in infants and children 6 wk through 6 yr of age (prior to seventh birthday).

  Contraindications Children who recovered from culture-confirmed pertussis; history of serious adverse reactions to previous dose of pertussis-containing vaccine; immediate anaphylactic reaction or encephalopathy occurring within 7 days after any DTP vaccination. (If contraindication to pertussis-vaccine component occurs, substitute diphtheria and tetanus toxoids for pediatric use [DT] for each of remaining doses.)

  Route/Dosage

It is recommended that the same brand of DTaP be given for all doses in the immunization series because no data exist on the interchangeability of DTaP vaccines.

Daptacel

Children IM Immunization is 4 doses of 0.5 mL at 2, 4, and 6 mo of age, at intervals of 6 to 8 wk and at 17 to 20 mo of age. The interval between the third and fourth dose should be at least 6 mo.

Infanrix

Children IM Primary immunization series is 3 doses at 0.5 mL at 4- to 8-wk intervals (preferably 8 wk). Customarily, the first dose is 2 mo of age (but may be given at 6 wk of age and up to the seventh birthday). A fourth dose (booster immunization) is recommended at 15 to 20 mo of age (interval between third and fourth dose at least 6 mo). A fifth dose is recommended at 4 to 6 yr of age in those who received all 4 doses by the fourth birthday. If the fourth dose is given after the fourth birthday, a fifth dose prior to school entry is not necessary.

Tripedia

Children IM Primary immunization series is 3 doses of 0.5 mL at 4- to 8-wk intervals. A fourth dose is recommended at 15 to 20 mo of age (interval between third and fourth dose at least 6 mo). A fifth dose is recommended at 4 to 6 yr of age, preferably prior to school entry. If the fourth dose is given after the fourth birthday, a fifth dose prior to school entry is not necessary.

  Interactions

Anticoagulants: Give DTaP with caution to persons on anticoagulant therapy. Immunosuppressants: May reduce vaccine's effectiveness. Influenza vaccine: To attribute causality of adverse reactions, do not give influenza vaccine within 3 days of pertussis vaccination.

  Lab Test Interferences None well documented.

  Adverse Reactions

DERMATOLOGIC: Rash. GI: Diarrhea or loose stools; vomiting. RESPIRATORY: Upper respiratory tract infection or rhinitis. OTHER: Fever; erythema, tenderness, induration (local); chills; fatigue; myalgia; arthralgia.

  Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Contraindicated for children less than 6 wk or 7 yr or older. Febrile illness or acute infection: Defer immunization during course of illness. Minor respiratory illness such as mild upper respiratory infection is usually not reason to defer immunization. Immunodeficiency: Defer immunization, if possible, until immunocompetency is restored. Thrombocytopenia or coagulation disorder that would contraindicate IM injection: Give vaccine with caution.

  Administration/Storage

• Administer drug by IM route only. Anterolateral aspect of thigh or deltoid muscle of upper arm is preferred. Do not inject in gluteal area or other areas with major nerve trunk.
• May administer vaccine with trivalent oral polio, injectable polio, Haemophilus b, hepatitis B, varicella, and measles, mumps, and rubella virus vaccines.
• Always record manufacturer's name and vaccine lot number in child's permanent record file, along with date of administration, name, address, and title of person administering vaccine.
• Shake vial well to ensure uniform suspension before withdrawing dose. If clumps remain after vigorous agitation, discard vial and contents. Rotate vial in palm to bring contents to room temperature before administration.
• Refrigerate vials; do not freeze. Discard frozen vaccine.

  Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Check patient's immunization history to ensure that at least 3 doses of DTP vaccine have previously been given. Give DTaP at least 6 mo after third DTP dose.
• Review patient's medical history for conditions that would contraindicate DTaP vaccine (eg, children who have recovered from culture-confirmed pertussis, history of serious adverse reactions to previous dose of DTaP, hypersensitivity to any component of vaccine, anaphylactic reaction or encephalopathy occurring within 7 days after any DTP vaccination).
• Take child's temperature to determine if infection is present.
• Defer immunization during course of any febrile illness or acute infection. Minor respiratory illness such as mild upper respiratory infection is not usually reason to defer immunization.
• Give any DTP injection with caution to children with thrombocytopenia or any coagulation disorder in whom IM injection may be contraindicated.
• When child returns for next dose in series of either pertussis or any DTP vaccine, question child's parent or guardian about side effects to previous dose. If any serious side effects are noted, additional pertussis vaccine may not be appropriate. Consult with child's pediatrician and continue childhood immunization with bivalent diphtheria and tetanus toxoids for pediatric use if recommended.
• There are no data on whether prophylactic use of antipyretic drugs (eg, acetaminophen) can decrease risk of febrile convulsions. Acetaminophen may reduce incidence of postvaccination fever. Immunization Practices Advisory Committee and American Academy of Pediatrics suggest administering appropriate dose of acetaminophen (based on age) at time of vaccination and q 4 to 6 hr to children at higher risk for seizures than general population (ie, children with personal or family history of seizures).

  Patient/Family Education

• Inform parent of name, action, administration, and side effects of DTaP.
• Provide parent with immunization history record and record this immunization in patient's medical record.
• Instruct patient to give acetaminophen for fever or local pain.
• If patient still requires 5th dose, inform parent of immunization schedule (5th dose: 4 to 6 yr).
• Advise parent to check with local school board; some school systems require that children receive 5th dose before entrance into kindergarten or elementary school.