Immunizations - Diptheria, Tetanus, and Pertussis

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If a child has a moderate or severe current or recent fever-related illness, vaccinations should be postponed until after recovery. Colds or other mild respiratory infections are no cause for delay. Parents should not be unduly concerned if the interval between shots is longer than that recommended. The immunity from any previous vaccinations persists, and the doctor does not have to start a new series from scratch.

Recommendations for Adults. All vaccinated adults should have a Td booster at least every 10 years throughout their lifetimes. A 2002 study reported that less than half of adult Americans ages 20 and older were protected against both tetanus and diphtheria, and immunity rates were even lower in those over 70. The results indicate that many people are not getting routine boosters.

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Other recommendations for adults are as follows:

• Adults who did not receive the primary childhood vaccinations should have the tetanus, diphtheria, and pertussis vaccine (Tdap vaccine) that was approved in 2005 every 10 years.
• Unvaccinated pregnant women should receive two doses of Td, properly spaced, and previously vaccinated women should have a booster.

Preventing Tetanus in Individuals with Wounds. Wounds that put patients at highest risk for tetanus are puncture wounds or wounds contaminated with dirt, feces, or saliva. However, any patient who requires medical care for any wound is a candidate for tetanus immunity.

Some considerations for tetanus vaccinations in wounded people are as follows:

• A booster is needed if the last shot was 5 or more years before the injury.
• Children under 7 are usually given DTP if they are not fully vaccinated.
• Most individuals are given the Td vaccination if they have been vaccinated.
• Older patients who had experienced an allergic response to a previous tetanus booster may be given the tetanus immune globulin (TIG).

Side Effects of Diphtheria-Tetanus-Pertussis (DTP) Vaccine

Allergic Reactions. In rare cases, people may be allergic to the DTP vaccine. Parents should tell their doctor if their children have any allergies. The DTaP vaccine may pose a slightly higher risk for an allergic reaction than the DTP. Children who have severe responses should not be given further vaccinations. A rash that occurs after a dose of DTP is of little consequence. In fact, it does not usually indicate an allergic response but only a temporary immune reaction and does not usually recur with subsequent shots. It should be noted that no deaths have been reported from allergic reactions, even severe (anaphylactic) ones, to the DTP vaccine.

Pain and Swelling at the Injection Site. Children may feel pain at the injection site. In some cases, a small lump may persist at the site for several weeks. Placing a clean, cool washcloth over any swollen, hot, or red area can help. Children should not be covered or wrapped tightly in clothes or blankets.