An article published in Family Physicians Association Magazine, Rajkot

 

 

DPT vaccines

Contents:        in each 0.5 ml vaccine

	Glaxo	Kasauli
Diphtheria toxoid	25 Lf	30Lf
Tetanus toxoid	5Lf	10Lf
B.Pertussis	20,000 million killed bacteria	32000 million killed bacteria
Adjuvant	2.5 mg aluminum phosphate	3.0 mg aluminum phosphate
Thiomersal BP	0.01%	0.01%

 

Age of vaccination and schedule:

First dose	6 to 8 weeks
Second dose	4to 8 weeks after 1st
Third dose	4 to 8 weeks after 2nd
1st booster	15 to 18 months
2nd booster	4 to 5 years
3rd booster	10 years

 

Storage:  lowermost compartment of freeze (not to be frozen)                    

Dose: 0.5 ml

Route of administration: Deep intramuscular

Site of administration: Anterolateral aspect of thigh

Instructions to mother: to give antipyretics, apply ice pack if local edema

Protection/ efficacy: Pertussis- 80%, Diphtheria and Tetanus almost 100%

Contra-indications: a. Progressive neurological disease

1. Uncontrolled convulsions

Side effects: Fever, excessive crying, local pain.

Complications: convulsions, screaming episodes, shock, encephalitis.

 

FAQs on DPT:

What should be done in case of lapse of more than six months between two primary doses of DPT?

Ans: The immunological memory once induced by a single dose of vaccine  is never lost irrespective of the time lapse. Hence there is no need of repeating the whole schedule no matter what the time lapse is.

 

• After completing 2 primary doses of DPT at age of 2 and 4 months, a patient comes directly at the age of 18 months. Should we give the third dose or the booster dose at this age?

Ans:   We should give a single dose of DPT at this age whether you call it as the third dose or the booster.

 

 

• What should be the minimum interval between third primary dose and the first booster dose?

Ans:  At least a period of six months. Because after six months the antibodies induced by the last dose of primary series wane away sufficiently to allow a meaningful antibody response to the booster dose.

 

 

• Why DPT is to be given deep intramuscular?

Ans:  To reduce local pain and inflammation, DPT is to be given deep intramuscular in the anterolateral aspect of thigh.

 

• How to manage local pain and induration at the local site?

Ans: Usually there is some pain and mild local reaction at the site of DPT injection which is relieved in two days. It can be managed with ice pack at local site, oral paracetamol or analgesic. However if the induration persists or increases even after two days, cellulites should be suspected and oral antibiotics be started.

 

• What should be done in case of a painless nodule at the site of DPT vaccination?

Ans: Parents should be reassured that nothing needs to be done and this will dissolve in due course of time.

 

• Which vaccines can be administered along with the DPT?

Ans: All vaccines except typhoid vaccine can be given along with DPT but at separate site.

 

• Can we use a vial of DPT vaccine which has been frozen accidentally, after rewarming it?

Ans: No, freezing and rewarming destroy the vaccine.

 

• Can DPT be given to a child with convulsion?

Ans: DPT can be given if the child is on anticonvulsive therapy and convulsions are under control. The child should be adviced to take antipyretics at the time of injection. If seizures are not under controlled DT should be given.

 

• Can children with cerebral palsy be given DPT?

Ans: Yes as cerebral palsy is a non-progressive disorder.

 

• Should DPT be given to a child who has already recovered after infection with pertussis or diphtheria?

Ans: Yes it should be given as per the recommendations.

 

• A child suffers from convulsion after first dose of DPT. Should second dose be given?

Ans: Convulsions occurring within 3 days and encephalopathy occurring within 7 days of immunization of DPT with or without fever should be considered due to DPT vaccine. IN such cases second and successive doses should be DT or accelular DPT.

 

• What is the critical age beyond which DPT should not be given and only DT is given?

Ans: DPT is not recommended after 7 years of age. DT is given after 7 years of age and Td after 10 years

 

• A child is not given any dose of DPT till 2 years of age. What should be done now?

Ans: Give 3 primary doses of DPT. First booster is to be given after 3 years of first dose if the child is <6years. If he is >6 years at age of starting of immunization, than 2 primary doses of DT and one booster needs to be given.

 

• What is the difference in the immunity of two children, one who has received 3 doses of DPT at 6, 10, 14 weeks and other who was irregular say 2, 28, 24 weeks?

Ans: the final immunity would be same in both the children but the second one would be susceptible till the second dose as one dose is not enough to induce immunity.

 

• Whether a tt injection is required in 15 months who is injured?

Ans: If the last dose of DPT was given before 6 months, the booster should be given at this age. There is no need of separate TT.

 

• Is injection of tt required after every injury?

Ans: If the previous immunization status is not known then both tt and tig should be given in unclean wounds. If three or more doses of DPT  are given, and the last dose was within five years there is no need of any tt. however in case of deep trauma and burns, it should be given if the duration since last immunization is more than 5 years.

 

• Can DPT be given to a child who has received immunoglobulin in the last 6-8 weeks?

Ans:  Yes because it is a toxoids and only live vaccines are to be avoided within 8 weeks of administration of immunoglobulin.

 

 

• What is Td which is recommended at 10 years of age?

Ans: Td contains the usual dose of tetanus toxoid but a smaller component of Diphtheria toxoids (4 Lf instead of 25Lf/dose). It helps in prolonging the protection of diphtheria after 10 years of age.

 

• Can DPT be given to a child who has suffered from measles before 3 weeks?

Ans: Yes, it can be safely given as measles depresses the cell mediated immunity and DPT acts by humoral immunity.

 

• Can DPT be given to a child on long term steroid therapy?

Ans: It can be safely given as it is not a live vaccine and only live vaccines are contraindicated during steroid therapy.

 

• Are acellular pertussis vaccines better than the routine vaccines?

Ans: The accelullar pertussis vaccines are as effective as the routine vaccines with only fewer side effects like pyrexia. They are not superior and can be offered to parents who are affording as it is very costly.

 

 

PS: This article was part of series of articles on practical points on vaccination in FPA times, 2013-14.

 

 

Dr. Neema Sitapara

MD (Ped), PGDip. (Adolescent Pediatrics)