National Travel Health Network and Centre
Diphtheria Vaccine Information
The Summary of Product Characteristics (SPC) for each vaccine product should be consulted for specific information [1-4].
Diphtheria toxoid vaccine is now only available as a combined vaccine. Separate diphtheria vaccine for use in adults and adolescents was discontinued in the UK in 2003.
Indications for use of vaccine [5]
Diphtheria vaccination is recommended for:
All infants from two months of age (routine immunisation programme)
Travellers to countries or areas where diphtheria is epidemic or endemic
Individuals at risk for exposure to diphtheria through their work; e.g. health care workers and microbiology laboratory technicians.
Individuals not previously immunised.
Availability of vaccine
There are four combined vaccines containing diphtheria toxoid that are licensed for use in the UK. Only one of these vaccines, Revaxis™ (dT/IPV), is licensed for use in adults. Diftavax™ is no longer being supplied and has been replaced by Revaxis™. See the table below for details.
Further information on the UK childhood vaccine program can be found on the Department of Health website [5].
Vaccine Schedules
Interrupted courses
It is unnecessary to restart an interrupted series of a vaccine or toxoid or to add extra doses, because the immune system has been primed [5]. Longer than recommended intervals between doses do not reduce antibody concentrations upon completion of the series, although protection may not be attained until the recommended number of doses has been administered [6].
Contraindications to Pediacel™[1] Repevax™[2] Infanrix IPV™[3] & Revaxis™[4]
Hypersensitivity reaction after previous administration of diphtheria, tetanus, pertussis or polio vaccines.
Known hypersensitivity to any component of the vaccine or to neomycin, polymyxin B or formaldehyde (which may be present in the vaccine as trace residues of manufacture).
Neurological complications of unknown origin within 7 days of previous vaccination.
Infanrix-IPV should not be administered to subjects who experienced an encephalopathy of unknown aetiology, occurring within 7 days following previous vaccination with a pertussis containing vaccine.
Adverse Events [reviewed in 5]
Pain, swelling or redness at the injection site are common and may occur more frequently following subsequent doses. A small, painless nodule may form at the injection site that usually resolves spontaneously. The incidence of local reactions is lower with diphtheria vaccines combined with acellular pertussis vaccines, than the reactions following vaccines combined with whole-cell pertussis, and are similar to reactions after DT vaccine.
Fever convulsions high pitched screaming and episodes of pallor, cyanosis and limpness occur rarely but with equal frequency after both DTaP and DT vaccines.
Confirmed anaphylaxis occurs extremely rarely. Data from the UK, Canada and the US point to rates of 0.65 to three anaphylaxis events per million doses. Other allergic conditions may occur more commonly and are not contraindications to further immunisation.
All suspected adverse reactions to vaccines occurring in children, or in individuals of any age after vaccines labelled with a black triangle (?), should be reported to the Medicines and Healthcare Products Regulatory Agency using the Yellow Card Scheme. Serious suspected adverse reactions to vaccines in adults should also be reported through the Yellow Card Scheme.
References
1. Sanofi Pasteur MSD Summary of Product Characteristics: Pediacel. Maidenhead: Sanofi Pasteur MSD. 21 September 2005. www.medicines.org.uk/searchresult.aspx?search=pediacel
2. Sanofi Pasteur MSD Summary of Product Characteristics: Repevax. Maidenhead: Sanofi Pasteur MSD. 23 September 2005. www.medicines.org.uk/searchresult.aspx?search=repevax
3. GlaxoSmithKline Summary of Product Characteristics: Infanrix-IPV. Middlesex: GlaxoSmithKline. 14 June 2005. www.medicines.org.uk/searchresult.aspx?search=infanrix
4. Sanofi Pasteur MSD. Summary of Product Characteristics: Revaxis. Maidenhead: Sanofi Pasteur MSD. 21 September 2005. www.medicines.org.uk/searchresult.aspx?search=revaxis
5. Salisbury DM, Begg NT, editors. Immunisation against Infectious Disease. London: HMSO; 1996 and 2005 Update http://www.dh.gov.uk/PolicyAndGuidance/
HealthAndSocialCareTopics/GreenBook/
GreenBookGeneralInformation/GreenBookGeneralArticle/fs/en?
CONTENT_ID=4097254&chk=isTfGX
(The link shows the 2005 updated chapters).
6. Centers for Disease Control. Morbidity & Mortality Weekly Report; General Recommendations on Immunization. Atlanta: CDC; February 8 2002 51 (RR02); 1-36 www.cdc.gov/mmwr/preview/mmwrhtml/rr5102a1.htm
Reading List
Plotkin S, Orenstein W, editors. Vaccines. 4th ed. Philadelphia: WB Saunders Co Ltd; 2004
Links
Centers for Disease Control. Morbidity & Mortality Weekly Report; General Recommendations on Immunization. Atlanta: CDC; February 8 2002 51 (RR02); 1-36 www.cdc.gov/mmwr/preview/mmwrhtml/rr5102a1.htm
Department of Health Joint Committee of Vaccination and Immunisation (JCVI) http://www.advisorybodies.doh.gov.uk/jcvi
Committee to Advise on Tropical Medicine and Travel (CATMAT) http://www.hc-sc.gc.ca/pphb-dgspsp/dird-dimr/vpd-mev/diphtheria_e.html
The Merck Manual of Medical Information online 2004 http://www.merck.com/mmhe/sec23/ch272/ch272d.html
World Health Organization (WHO) http://www.who.int/health_topics/diphtheria/en
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