Diphtheria / Tetanus / Polio
Diphtheria is a highly infectious disease affecting the throat and upper airways, caused by the diphtheria bacterium. The disease is found worldwide and high vaccination uptake is required to keep the rates of infection low. It is still prevalent in many countries due to low immunisation levels, especially the Indian Subcontinent, Central and South East Asia, Africa and South America.
Infection is spread person to person through coughing or sneezing.
Diphtheria is an extremely serious illness and treatment is required as soon as the disease is suspected to prevent fatality. The incubation period is 2-5 days and symptoms include fever, sore throat, enlarged glands in the neck. If not treated early, the infection can cause obstruction of the airway and is fatal in 5-10% of cases. Fatality rates are higher in young children and older adults. Damage to the heart muscle and nervous system can also occur with the illness.
Intensive care support is required. Early administration of Diphtheria antitoxin helps reduce fatality, as does antibiotics.
There is a highly effective vaccine against Diphtheria, which is included in the childhood immunisations programme of most countries.
Tetanus is a life threatening infection caused by a bacteria that is found in the environment worldwide.
The bacteria enters the body through skin wounds or cuts, especially soil contaminated wounds.
The incubation period is 4-21 days. Symptoms are due to muscles spasms and rigidity and include lock jaw and paralysis of the respiratory muscles. Death rates vary from 10% (if good intensive medical care is available) to 90%. Children and older adults are especially vulnerable.
Treatment includes intensive medical care, tetanus Immunoglobulin and wound care.
Vaccination is the mainstay of prevention as it is not possible to eradicate the bacteria from the environment.
Poliomyelitis (polio) is a highly infectious viral disease, which mainly affects young children. Since the launch of the Global Eradication Programme led by WHO, the incidence of Polio has fell by 99% since 1988. The disease is now endemic in 2 countries-Pakistan and Afghanistan. However, sporadic outbreaks still occur due to imported disease or as result of the oral polio vaccine virus reverting to infectious type.
The virus is transmitted through the personal contact and contaminated food and water.
The virus spreads from the gut to the nervous system causing paralysis. Irreversible paralysis occurs in 1 in 200 cases of polio and the death rate is 5-10% due to respiratory failure.
There is no treatment for polio infection and good supportive care is required.
The success of the Polio eradication programme is related to widespread vaccination campaign.
DTP Vaccine (Revaxis)
Diphtheria, Tetanus and Polio are contained in a single combined vaccine. The vaccine is inactivated and contains dead bacteria or virus only and is highly effective at preventing the infections. Immunity does wane over time. Therefore, further vaccinations may be required. Separate vaccines against the diseases are not available in the UK. The Department of Health does not recommend the use of the oral polio vaccine due to the potential risks associated with this live vaccine.
The combined vaccine is give in the UK childhood programme with pertussis (whooping cough) at age 2 months, 3 months and 4 months. Further booster doses are given at 3-5 years of age and again at 14 years of age.
The vaccine can be given to adults and children from 10 years of age travelling to areas where they will be at risk of Tetanus, Polio and Diphtheria infections.
Provided that childhood immunisations are up to date, DTP vaccine only needs to be given as a single dose prior to travel to risk areas. If individuals who have previously been immunised, the vaccine provides immediate protection.
|Age range||Method of Administration||Number of doses||Booster Requirement|
|From 10 yrs of age||Intramuscular injection to the deltoid muscle||1 dose||Booster required every 10 yrs if travelling to developing countries|
Further doses are required at 10 yearly intervals for ongoing risk in travellers.
The vaccine cannot be given:
- To children under 10 years of age. This is because protection is also required against pertussis (whooping cough), which is not covered by the DTP vaccine.
- If there is a history of severe allergic reaction to a previous dose of the vaccine or any of it’s components.
- If there is a history of severe allergic reaction to Neomycin, Streptomycin and Polymyxin B (antibiotics used in the manufacturing process).
- If there is an acute illness associated with fever (greater than 38.5 degrees Celsius).
- If there is an unstable neurological condition, such as uncontrolled epilepsy.
There have been no toxic effects seen when the vaccine has been given to pregnant women. Therefore, the vaccine can be given if there is considered to be significant risk of infection.
The vaccination can be given to breast feeding mothers if there is a clinical indication to do so. Inactivated vaccines have not be shown to cause serious side effects to breast fed infants.
Common Side Effects
- Local injection reactions-pain, swelling, redness and small painless lump can occur.
- Fever, muscle aches, headache, nausea and vomiting can occur.
Interactions with Other Vaccines
The combined can be given at the same time or any time before or after other vaccines including
- Hepatitis A
- Hepatitis B
- Japanese encephalitis
- Cholera vaccine
- MMR combined vaccine and all other vaccines in the UK immunisation schedule.
Frequently Asked Questions
1) Is the vaccine safe?
The vaccine contains inactivated organisms and cannot cause the infections in the vaccinated individual, nor is the vaccinated individual infectious to others. The vaccine has been rigorously tested prior to release and there is much post marketing data confirming it’s safety. Rarely, neurological complications have been associated with the vaccine. This includes Guillian Barre Syndrome and a condition called HHE, which is associated with fever, convulsions, high-pitched screaming and episodes of pallor, cyanosis (blue discolouration of the fingers or around the mouth) and limpness.
2) What are the contents of the vaccine?
In addition to inactivated bacteria and virus, the vaccine contains the following:
- Medium 199 (a complex medium of amino acids, mineral salts, vitamins, polysorbate 80 and other substances diluted in water for injections).
- Water for injections
- Traces of neomycin, streptomycin and polymyxin B (antibiotics) may be found in the vaccine.
The vaccine does not contain:
3) What is the vaccine schedule if there is an uncertain history of childhood immunisations?
If there is no clear history of having received the vaccines during childhood, then the following schedule should be given:
3 doses of the vaccine, given at intervals of 1 month.
A first booster should be given at 5 years after this and a second booster at 10 years.
4) How can I obtain the vaccine for a child under 10 years, if required for travel?
Children under 10 years requiring further doses of the vaccine for travel would need to see their GP to obtain the vaccine. This is because under 10 years, the vaccine is given in combination with pertussis.
5) I understand that I need a certificate of polio vaccination if travelling to Pakistan or Afghanistan; can this be provided by CityDoc?
Under temporary recommendations set by the WHO, anyone departing from Pakistan or Afghanistan need to show proof of vaccination to avoid receiving a dose of the oral polio vaccine. The oral polio vaccine is live and therefore, cannot be given to anyone who is pregnant, immunosuppressed or breastfeeding. Additionally, the vaccine virus is released in faeces, leading to potential spread of infection.
It is advised that if you are travelling to these countries, you should get proof of vaccination on an international certificate (same as for yellow fever vaccine).
If you have received the vaccination at a CityDoc clinic, we can issue the certificate for you.
If you have received the vaccine at another clinic, we would require the details of the vaccination such as date given, brand name, batch number before we can issue the certificate. This includes children under 10 years who will have the details of the vaccine on their GP records.
Importantly, if you are travelling to these countries for more than 4 weeks, you need to have received the vaccine within 12 month and not 10 years.
As the vaccine is inactivated, there are no serious side effects associated with receiving further doses of the vaccine.
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