The DPT vaccine or DTP vaccine is a class of combination
vaccine
A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified. s against three
infectious disease
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...
s in humans:
diphtheria
Diphtheria is an infection caused by the bacterium '' Corynebacterium diphtheriae''. Most infections are asymptomatic or have a mild clinical course, but in some outbreaks more than 10% of those diagnosed with the disease may die. Signs and s ...
,
pertussis
Whooping cough, also known as pertussis or the 100-day cough, is a highly contagious bacterial disease. Initial symptoms are usually similar to those of the common cold with a runny nose, fever, and mild cough, but these are followed by two or t ...
(whooping cough), and
tetanus
Tetanus, also known as lockjaw, is a bacterial infection caused by ''Clostridium tetani'', and is characterized by muscle spasms. In the most common type, the spasms begin in the jaw and then progress to the rest of the body. Each spasm usually ...
.
[ ] The vaccine components include diphtheria and tetanus
toxoids
A toxoid is an inactivated toxin (usually an exotoxin) whose toxicity has been suppressed either by chemical (formalin) or heat treatment, while other properties, typically immunogenicity, are maintained. Toxins are secreted by bacteria, whereas ...
and either killed whole cells of the
bacterium
Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were amon ...
that causes pertussis or pertussis antigens. The term toxoid refers to vaccines which use an inactivated toxin produced by the pathogen which they are targeted against in order to generate an immune response. In this way, the toxoid vaccine generates an immune response which is targeted against the toxin which is produced by the pathogen and causes disease, rather than a vaccine which is targeted against the pathogen itself. The whole cells or
antigen
In immunology, an antigen (Ag) is a molecule or molecular structure or any foreign particulate matter or a pollen grain that can bind to a specific antibody or T-cell receptor. The presence of antigens in the body may trigger an immune respons ...
s will be depicted as either "DTwP" or "DTaP", where the lower-case "w" indicates whole-cell inactivated pertussis and the lower-case "a" stands for “acellular”. In comparison to alternative vaccine types, such as live attenuated vaccines, the DTP vaccine does not contain the pathogen itself, but rather uses inactivated toxoid to generate an immune response; therefore, there is not a risk of use in populations that are immune compromised since there is not any known risk of causing the disease itself. As a result, the DTP vaccine is considered a safe vaccine to use in anyone and it generates a much more targeted immune response specific for the pathogen of interest. However, booster doses are recommended every ten years to maintain immune protection against these pathogens.
In the United States, the DPT vaccine was administered as part of the childhood vaccines recommended by the
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
(CDC) until 1996 when the acellular DTaP vaccine was licensed for use.
History
In the 20th century, the advancements in vaccinations helped to reduce the incidence of childhood pertussis and had a dramatically positive effect on the health of populations in the United States. However, in the early 21st century, reported instances of the disease increased 20-fold due to a downturn in the number of immunizations received and resulted in numerous fatalities.
During the 21st century, many parents declined to vaccinate their children against pertussis for fear of perceived side effects despite scientific evidence showing vaccines to be highly effective and safe.
In 2009, the journal ''
Pediatrics'' concluded the largest risk among unvaccinated children was not the contraction of side effects, but rather the disease that the vaccination aims to protect against.
Diphtheria and tetanus toxoids and pertussis (DTP) vaccination was licensed in 1949. Since the introduction of the combination vaccine, there has been an extensive decline in the incidence of pertussis, or whooping cough, the disease which the vaccine protects against. Additionally, the rates of disease have continued to decline as more extensive immunization strategies have been implemented, including booster doses and increased emphasis on increasing health literacy.
Vaccination Rates
In 2016, the CDC reported that 80.4% of children in the US have received 4 or more DTaP vaccinations by 2 years of life.
Vaccination rates for children aged 13–17 with one or more TDaP shots was 90.2% in 2019.
Only 43.6% of adults (older than 18) have received a TDaP shot in the last 10 years.
The CDC aims to increase vaccination rate among 2 year olds from 80.4% to 90.0%
Combination vaccines with acellular pertussis
DTaP and Tdap are both
combination vaccines against diphtheria, tetanus, and pertussis. The lower-case "d" and "p" indicate smaller concentrations of diphtheria toxoids and pertussis antigens, and "a" in "ap/aP" indicates that the pertussis toxoids are acellular.
DTaP
DTaP
The DPT vaccine or DTP vaccine is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis (whooping cough), and tetanus. The vaccine components include diphtheria and tetanus toxoids and either kille ...
(also DTPa and TDaP) is a combination vaccine against
diphtheria
Diphtheria is an infection caused by the bacterium '' Corynebacterium diphtheriae''. Most infections are asymptomatic or have a mild clinical course, but in some outbreaks more than 10% of those diagnosed with the disease may die. Signs and s ...
, tetanus, and
pertussis
Whooping cough, also known as pertussis or the 100-day cough, is a highly contagious bacterial disease. Initial symptoms are usually similar to those of the common cold with a runny nose, fever, and mild cough, but these are followed by two or t ...
, in which the pertussis component is acellular.
[ ] This is in contrast to whole-cell, inactivated DTP (DTwP). The acellular vaccine uses selected antigens of the pertussis pathogen to induce immunity.
Because it uses fewer antigens than the whole-cell vaccines, it is considered to cause fewer side effects, but it is also more expensive.
Research suggests that the DTP vaccine is more effective than DTaP in conferring immunity, because DTaP's narrower antigen base is less effective against current pathogen strains.
Tdap
Tdap, (also dTpa), is a tetanus toxoid, reduced diphtheria toxoid, and
acellular pertussis vaccine
Pertussis vaccine is a vaccine that protects against whooping cough (pertussis). There are two main types: whole-cell vaccines and acellular vaccines. The whole-cell vaccine is about 78% effective while the acellular vaccine is 71–85% effectiv ...
. It was licensed in the United States for use in adults and adolescents on 10 June 2005.
Two Tdap vaccines are available in the US. In January 2011, the US
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
(CDC)
Advisory Committee on Immunization Practices
The Advisory Committee on Immunization Practices (ACIP) is a committee within the United States Centers for Disease Control and Prevention (CDC) that provides advice and guidance on effective control of vaccine-preventable diseases in the U.S. c ...
(ACIP) recommended the use of Tdap in adults of all ages, including those age 65 and above. In October 2011, in an effort to reduce the burden of pertussis in infants, the ACIP recommended that unvaccinated pregnant women receive a dose of Tdap. On 24 October 2012, the ACIP voted to recommend the use of Tdap during every pregnancy.
[ ]
The ACIP and Canada's
National Advisory Committee on Immunization
The National Advisory Committee on Immunization (NACI; french: Comité consultatif national de l'immunisation; french: CCNI, label=none) is an advisory body that provides the Government of Canada with medical and scientific advice relating to h ...
(NACI) recommended that both adolescents and adults receive Tdap in place of their next Td booster (recommended to be given every ten years).
[ ] Tdap and Td can be used as
prophylaxis
Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...
for tetanus in wound management. People who will be in contact with young infants are encouraged to get Tdap even if it has been less than five years since Td or TT to reduce the risk of infants being exposed to pertussis. NACI suggests intervals shorter than five years can be used for catch-up programs and other instances where programmatic concerns make five-year intervals difficult.
The
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
(WHO) recommends a
pentavalent vaccine
A pentavalent vaccine, also known as a 5-in-1 vaccine, is a combination vaccine with five individual vaccines conjugated into one.
Pentavalent vaccine frequently refers to the 5-in-1 vaccine protecting against diphtheria, tetanus, whooping coug ...
, combining the DTP vaccine with vaccines against
''Haemophilus influenzae'' type B and
hepatitis B
Hepatitis B is an infectious disease caused by the '' Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection.
Many people have no symptoms during an initial infection. ...
. Evidence on how effective this pentavalent vaccine is compared to the individual vaccines has not yet been determined.
A 2019 study in the ''
American Economic Journal
The ''American Economic Journal'' is a group of four peer-reviewed academic journals published by the American Economic Association. The names of the individual journals consist of the prefix ''American Economic Journal'' with a descriptor of the f ...
'' found that state requirements mandating the use of the Tdap vaccine "increased Tdap vaccine take-up and reduced pertussis (whooping cough) incidence by about 32 percent."
Related combination vaccines
Excluding Pertussis
DT and Td vaccines, lack the pertussis component.
The Td vaccine is administered to children over the age of seven as well as to adults. It is most commonly administered as a booster shot every 10 years.
The Td booster shot may also be administered as protection from a severe burn or dirty wound.
The DT vaccine is given to children under the age of seven, who are unable to receive the pertussis antigen in the DTaP vaccine due to a contraindication.
Including Polio
In the United States, a combined vaccine inactivated polio vaccine (IPV), DTaP, and
hepatitis B
Hepatitis B is an infectious disease caused by the '' Hepatitis B virus'' (HBV) that affects the liver; it is a type of viral hepatitis. It can cause both acute and chronic infection.
Many people have no symptoms during an initial infection. ...
vaccine is available for children.
In the UK, all babies born on or after 1 August 2017 are offered a hexavalent vaccine: DTaP, IPV, ''
Haemophilus influenzae
''Haemophilus influenzae'' (formerly called Pfeiffer's bacillus or ''Bacillus influenzae'') is a Gram-negative, non-motile, coccobacillary, facultatively anaerobic, capnophilic pathogenic bacterium of the family Pasteurellaceae. The bacter ...
'', and hepatitis B.
Contraindications
The DPT vaccine should be avoided in persons who experienced a severe allergic reaction, such as
anaphylaxis
Anaphylaxis is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of use of emergency medication on site. It typically causes more than one of the foll ...
, to a past vaccine containing tetanus, diphtheria, or pertussis. It should also be avoided in persons with a known severe allergy to an ingredient in the vaccine. If the reaction was caused by tetanus toxoids, the CDC recommends considering a passive immunization with
tetanus immune globulin
Anti-tetanus immunoglobulin, also known as tetanus immune globulin (TIG) and tetanus antitoxin, is a medication made up of antibodies against the tetanus toxin. It is used to prevent tetanus in those who have a wound that is at high risk, have ...
(TIG) if a person has a large or unclean wound. The DPT vaccine should also be avoided if a person developed
encephalopathy
Encephalopathy (; from grc, ἐνκέφαλος "brain" + πάθος "suffering") means any disorder or disease of the brain, especially chronic degenerative conditions. In modern usage, encephalopathy does not refer to a single disease, but r ...
(seizures, coma, declined consciousness) within seven days of receiving any pertussis-containing vaccine and the encephalopathy cannot be traced to another cause.
A DT vaccine is available for children under the ages of seven who have contraindications or precautions to pertussis-containing vaccines.
Side effects
DTaP
Common side effects include
soreness
Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...
where the shot was given, fever, irritability, tenderness, loss of appetite, and vomiting.
Most side effects are mild to moderate and may last from one to three days.
More serious but rare reactions after a DTaP vaccination may include seizures, lowered consciousness, or a high fever over .
Allergic reactions are uncommon, but are medical emergencies. Signs of an allergic reaction include hives, dyspnea, wheezing, swelling of face and throat, syncope, and tachycardia and the child should be rushed to the nearest hospital.
Tdap
Common side effects include pain or swelling where the shot was given, mild fever, headache, tiredness, nausea, vomiting, diarrhea, and stomach ache.
Allergic reactions are possible and have the same presentation and indications as described above for allergic reactions in DTaP. Any individual who has experienced a life-threatening allergic reaction after receiving a previous dose of diphtheria, tetanus, or pertussis containing vaccine should not receive the Tdap vaccination.
In pregnant women, research suggests that Tdap administration may be associated with an increased risk of chorioamnionitis, a placental infection.
Increased incidence of fever is also noted in pregnant women.
Despite the observed increase in incidence of chorioamnionitis in pregnant women following Tdap administration, there has been no observed increase in the incidence of preterm birth, for which chorioamnionitis is a risk factor.
Research has not discerned an association between Tdap administration during pregnancy and other serious pregnancy complications such as neonatal death and stillbirth.
An association between Tdap administration during pregnancy and pregnancy-related hypertensive disorders (such as
pre-eclampsia) has not been identified.
Immunization schedules and requirements
France
In France, DTP refers to a diphtheria, tetanus and polio vaccine. It is mandatory and given at 2 months (1st dose) and 4 months (2nd dose) with a booster at 11 months. Subsequent boosters are recommended at ages 6, 11–13, 25, 45, 65, then every ten years.
Netherlands
In the Netherlands, pertussis is known as ''kinkhoest'' and DKTP refers to the DTaP-IPV combination vaccine against diphtheria, kinkhoest, tetanus, and polio. DTP is given as part of the National Immunisation Programme.
United Kingdom
In the United Kingdom, DTP is called the "3-in-1 teenage booster" and protects against tetanus, diphtheria and polio. It is given by the NHS to all teenagers aged 14 (the
hexavalent vaccine
A hexavalent vaccine, or 6-in-1 vaccine, is a combination vaccine with six individual vaccines conjugated into one, intended to protect people from multiple diseases. The term usually refers to the children's vaccine that protects against dipht ...
is given to infants and provides the first stage of protection against diphtheria, tetanus, and polio, as well as pertussis, Haemophilus influenzae type B and Hepatitis B). Subsequent boosters are recommended for foreign travellers where more than 10 years has passed since their last booster. This is provided on the NHS free of charge due to the significant risk that an imported case of polio could pose to public health in Britain.
United States
The standard immunization regimen for children within the United States is five doses of DTaP between the ages of two months and fifteen years. To be considered fully vaccinated, the
Center for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
(CDC) typically requires five doses of Tdap.
The CDC recommends that children receive their first dose at two months, the second dose at four months, the third dose at six months, the fourth dose between 15 and 18 months, and the fifth dose between 4–6 years. If the fourth dose of the DTaP immunization regimen falls on or subsequent to the recipient's fourth birthday, the CDC states that only four doses are required to be fully vaccinated.
In the instance that an individual under 18 has not received the DTaP vaccine, individuals should be vaccinated on the schedule in accordance with the vaccination "catch up schedule" provided by the CDC.
Infants younger than 12 months of age, specifically less than three months of age, are at highest risk of acquiring pertussis.
In U.S, there is no current tetanus-diphtheria-pertussis vaccination (whooping cough) recommended or licensed for new born infants.
As a result, in their first few months of life, unprotected infants are at highest risk of life-threatening complications and infections from pertussis. Infants should not receive pertussis vaccination younger than six weeks of age. Ideally, Infants should receive
DTaP
The DPT vaccine or DTP vaccine is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis (whooping cough), and tetanus. The vaccine components include diphtheria and tetanus toxoids and either kille ...
(name of whooping cough vaccine for children from age 2 months through 6 years) at 2, 4, 6 months of age and they are not protected until the full series is completed.
To protect infants younger than twelve months of age not vaccinated with Tdap against pertussis, ACIP also recommends adults (e.g., parents, siblings, grandparents, childcare providers, and healthcare personnel) and children to receive Tdap at least two weeks before being in contact with the infant.
The CDC recommends that adults who have received their childhood DTP series receive a Td or Tdap booster every ten years.
For adults that have not received the DTP series, the CDC recommends a three-part vaccine series followed by a Td or Tdap booster every ten years.
In pregnancy
According to the CDC's
Advisory Committee on Immunization Practices (ACIP) guidelines, one dose of Tdap is recommended during each pregnancy to ensure protection against pertussis in newborn infants.
[ ] Optimal timing to administer a dose of Tdap during each pregnancy is between 27 through 36 weeks gestation.
If Tdap is administered early in pregnancy, it is not recommended to administer again during the 27 through 36 weeks gestation period as only one dose is recommended during pregnancy. In October 2022, Boostrix (Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed
dap was approved for immunization during the third trimester of pregnancy to prevent pertussis, commonly known as whooping cough, in infants younger than two months of age.
Pregnant women who have not previously vaccinated with Tdap (i.e., have never received DTP, DTaP, or DT as child or Td or TT as an adult) are recommended to receive a series of three Td vaccinations starting during pregnancy to ensure protection against maternal and neonatal tetanus.
[Health Care Guideline: Routine Prenatal Care. Fourteenth Edition.](_blank)
By the Institute for Clinical Systems Improvement. July 2010. In such cases, administration of Tdap is recommended after 20 weeks' gestation,
and in earlier pregnancy a single dose of Tdap can be substituted for one dose of Td, and then the series completed with Td.
For pregnant women not previously vaccinated with Tdap, if Tdap is not administered during pregnancy, it should be administered immediately postpartum.
Postpartum administration of TDaP is not equivalent to administration of the vaccination during pregnancy.
Because the vaccine is administered postpartum, the mother is unable to develop antibodies that can be transferred to the infant in utero, consequently, leaving the infant vulnerable to the diseases preventable by the Tdap Vaccine.
Postpartum administration of the TdaP vaccine to the mother seeks to reduce the likelihood that the mother will contract disease that can be subsequently passed on the infant, albeit there will still be a two week period prior to the protective effects of the vaccine setting in.
Postpartum administration is an extension of the concept of "cocooning," a term that refers to the full vaccination of all individuals that may come into direct contact with the infant.
Cocooning, like postpartum Tdap aministration, is not recommended by the CDC.
Cocooning depends on ensuring full vaccination of all individuals that the infant may come into contact with, and there may be financial, administrative or personal barriers that preclude full and timely vaccination of all individuals within the "cocoon."
Brand names
Australia
United Kingdom
Brand names in the United Kingdom include Revaxis (Sanofi Pasteur).
United States
, there are six DTaP vaccines and two Tdap vaccines licensed and available for use in the United States.
All of them are indicated as childhood vaccinations with the schedules as follows:
References
Diphtheria
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Pertussis
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Tetanus
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External links
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{{DEFAULTSORT:Dpt Vaccine
Vaccines
Combination drugs
Combination vaccines
Diphtheria
Polio
Tetanus
Whooping cough