Diphtheria, Tetanus, Pertussis and the DTaP Vaccine

Diphtheria, tetanus and pertussis are very serious bacterial diseases. While diphtheria and pertussis spread from person to person, tetanus enters the body through broken skin. Before the DTaP vaccine became available to the public, roughly 200,000 people contracted diphtheria and tetanus, and hundreds caught tetanus in the United States alone. Since then, tetanus and diphtheria cases have dropped by about 99%, and pertussis cases by about 92% in this country.

What is diphtheria?

What causes diphtheria is the Diphtheria toxin produced by the C. diphtheriae that infects the upper respiratory tract. The bacterial infection causes a thick coating in the back of the nose or throat, which makes it difficult to breathe or swallow. Other complications include paralysis, heart failure, and even death. Milder forms of diphtheria may only affect the skin. The name is derived from the Greek word “leather”, diphtheria, describing the thick coating of the throat.

What is tetanus?

Tetanus is a bacterial infection caused by Clostridium tetani which lives in soil, dust, saliva and manure. The bacteria enter the body through broken skin, such as cuts, scratches or bites. Stepping on a dirty nail or getting bit by an animal are common ways to contract tetanus. The illness is characterized by a prolonged, painful contraction of the muscles that normally affects the whole body. It can also lead to “lockjaw”, which makes it impossible to open the mouth and can eventually lead to death. The name is rooted in the Greek words tetanos, “taut”, and teinein, “to stretch”.

What is pertussis?

Pertussis, more commonly known as whooping cough, is a highly contagious respiratory disease caused by the bacterium Bordetella pertussis. Pertussis is accompanied by uncontrollable, violent coughing fits that can have an infected person need to take deep breathes which make a “whooping” sound.  In some countries, this disease is called the 100 days’ cough or cough of 100 days. The disease is especially common among infants and young children. It can be fatal, particularly for children less than 1 year of age.

Where does diphtheria come from?

The earliest reported epidemic of diphtheria occurred in 1613 in Spain and is known as “El Año de los Garotillos” (The Year of Strangulations) in history of Spain. The disease spread from Europe and the New World during the following centuries. Edwin Klebs identified the bacterium and named it Klebs-Loeffler bacterium in 1883. The first immunizations of animals against the illness with heat-treated diphtheria toxin took place in the late 18th century, but it was not until the 1920s that a save diphtheria vaccine was developed.

What does tetanus come from?

The link between wounds and fatal muscle spasms was already known to ancient peoples. In 1884, Arthur Nicolaier isolated the tetanus toxin from free-living, anaerobic bacteria. The same year, Antonio Carle and Giorgio Rattone demonstrated the transmissibility of the disease. In 1891, Kitasato Shibasaburo first isolated C. tetani from a human victim. A few years later, Edmond Nocard showed that the tetanus antitoxin induced immunity in humans, which lead to the development of the tetanus vaccine (tetanus toxoid vaccine) in 1924.

Where does pertussis come from?

The disease was first recognized in the Middle Ages and referred to as “the kink” ( a Scottish term for fit) or kindhoest (a Germanic word for child’s cough). The first epidemic was described by Guillaume de baillou in Paris in 1578. The bacterium B. pertussis was first isolated in 1906 by Jules Bordet and Octave Gengou, who also began to work on the first vaccine for pertussis soon thereafter. Louis W. Sauer created the first pertussis vaccine in the 1920s.  In 1942, the American scientist Pearl Kendrick combined the whole-cell pertussis vaccine with diphtheria and tetanus toxoids to generate the first DTP combination vaccine.

How is diphtheria transmitted?

Diphtheria is spread through direct contact with secretions that contain the C. diphtheriae from an infected person. This usually occurs when the infected person sneezes or coughs and another person inhales these aerosolized secretions. Moreover, the disease can also be spread through coming in contact with surfaces that carry the bacteria. A person can be contagious for up to 2 weeks after infection.

How is tetanus transmitted?

Tetanus infection typically occurs when an object contaminated with C. tetani comes into contact with broken skin, normally through injury. There are certain breaks in the skin that are more at risk for tetanus infection, such as wounds contaminated with dirt, feces or spit, wounds caused by an object puncturing the skin (like a nail or needle), burns, crush injuries, and injuries with dead tissue. In very rare cases, tetanus infections may also occur via surgical procedures, insect bites, dental infections, compound fractures, chronic sores, and intravenous drug use.

How is pertussis transmitted?

Pertussis spreads when an infected person sneezes or coughs, spraying tiny droplets containing B. pertussis bacteria through the air, and another person inhales these droplets. The incubation period is normally 7-10 days, but can last over a month. Although cases of pertussis have dropped dramatically in the United States since the introduction of the pertussis vaccine, the disease has caused widespread outbreaks in recent years due to dropping vaccination rates. In 2012, nearly 50,000 cases of whooping cough were reported, the most cases since 1955, and including 20 deaths.

What are diphtheria symptoms?

The incubation period of diphtheria is normally 2-5 days. As the illness usually affects the nose and throat, the first symptoms of diphtheria include a cold, sore throat, swollen glands in the neck, fever, and chills. Next, the diphtheria toxin causes thick coating on the back of the nose or throat, which may be blue or grayish green. The coating makes it hard to breathe or swallow, and can get so thick that it blocks the airway. About 1 out of 10 people who get diphtheria dies.

What are tetanus symptoms?

The incubation period of tetanus is typically about 8 days, but can lead up to several months, depending on how far the injury is from the central nervous system. The shorter the incubation period, the more severe the symptoms. The first signs of tetanus include lockjaw, as well as spasms in the chest, neck, back, abdominal muscles, and buttocks. Back muscle spasms often cause arching, called opisthotonos. Prolonged muscle spasms cause sudden, strong and painful contractions of whole muscle groups, called “tetany,” which can cause muscle fractures and tears. Other symptoms of tetanus include drooling, sweating, fever, irritability, and uncontrolled urination and defecation. Breathing difficulty is fatal in 10-20% of cases.

What are pertussis symptoms?

The first symptoms of whooping cough include runny nose, sneezing, and a mild cough, which may seem like a typical cold. A mild fever also typically appears. Then, the cough becomes more severe until the infected person experiences fits of rapid, violent coughing followed by the “whooping” sound as they try to inhale. During the coughing fit, the patient may turn blue. While symptoms may be less severe for adults, pertussis can be life-threatening for infants and young children. The infection usually lasts 6 weeks.

What is the DTaP vaccine?

Immunization against diphtheria, tetanus and pertussis comes in the combination DTaP vaccine. The DTaP vaccination replaced the previously used DTP shot which protected against the same three diseases, but used a whole-cell preparation in the pertussis component (inactivated, but complete Bordetella pertussis bacteria). The DTaP combination vaccine, however, only uses parts of the B. pertussis bacterium, together with diphtheria and tetanus toxoids. There is a similar combination vaccine available called Tdap which offers booster protection against tetanus, diphtheria, and pertussis. The difference (DTaP vs Tdap) is that while the former is only given to children under the age of 6, the latter is given to adolescents and adults over the age of 19. The Upper-case letters in these abbreviations denote full-strength doses, while lower-case letters denote reduced doses used in adolescent/adult formulations; the “a” in DTaP and Tdap stands for “acellular”. Other combination vaccines to prevent diphtheria, tetanus and pertussis are DT (given to children under the age of 7) and Td (given to older children and adults). DTaP should be given to children in 5 doses (at the ages 2, 4, 6, and 15-18 months and 4-6 years). DT does not contain pertussis, and is used as a substitute for DTaP for children who cannot tolerate pertussis vaccine. Td is a given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under certain circumstances (commonly referred to as “tetanus shot”). All vaccines are administered via intramuscular injections. None of these vaccine causes diphtheria, tetanus or pertussis.

What are the DTaP vaccine side effects?

Getting diphtheria, tetanus or pertussis disease is much riskier than getting the DTaP shot. The side effects of the DTaP vaccine are usually mild, such as fever, redness or swelling where the shot was given, and soreness or tenderness where the shot was given. These problems occur more often after the 4th and 5th doses of the DTaP series than after earlier doses. Other symptoms occurring after the 4th or 5th dose include swelling of the entire arm or leg. Other symptoms may be fussiness, fatigue, poor appetite, and vomiting, which usually occur 1-4 days after the shot. Moderate problems include seizure, non-stop crying and high fever, though they are very uncommon. Severe problems, which are very rare, caused by severe allergic reactions can be long-term seizures, coma and permanent brain damage, although it is unclear whether these complications were caused by the vaccine. The symptoms accompany the booster shots for adolescents and adults are typically very mild or non-existent. Tdap side effects may include pain, redness, and swelling where the shot was given, mild fever, headache, nausea, chills, and body aches. Tetanus shot side effects include pain, redness, and swelling where the shot was given, mild fever, headache and fatigue. In rare cases, higher fever may occur. In very rare cases, severe pain and bleeding where the Tdap or Td shot was given may appear.

Who should not get the DTaP vaccine?

The DTaP vaccine is only licensed for children less than 7 years of age. However, children who had a life-threatening allergic reaction after a dose of DTaP should not get another dose. Any child who suffered a brain or nervous system disease within 7 days after a dose of DTaP should not get another dose, either. Children who are severely ill during the time of the scheduled DTaP vaccination should wait until they recover. People with life-threatening allergic reaction after a dose of any tetanus, diphtheria or pertussis containing vaccine, or with a severe allergy to any part of the Tdap or Td vaccine, should not get any of these vaccines. If a person was in a coma, or had long or multiple seizures within 7 days after a childhood dose of DTP or DTaP, they should not get Tdap, unless a cause other than the vaccine was found. However, they can still get Td.

Sources:

http://www.cdc.gov/vaccines/vpd-vac/diphtheria/fs-parents.html

http://www.nlm.nih.gov/medlineplus/diphtheria.html

http://www.cdc.gov/tetanus/about/index.html

 

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