Iowa Health Book: Pediatrics

Diphtheria, Tetanus, and Pertussis: What You Need to Know

Please read this pamphlet before you or your child gets a vaccine!
Before vaccines were available, most children caught pertussis. Also, hundreds of people became ill with tetanus each year and thousands became ill with diphtheria.

The benefits of the vaccines to prevent these three diseases are greater than the possible risks for almost all people. A person who receives vaccines benefits from the protection they provide. When many people are vaccinated, everyone benefits because the chance for spread of disease is reduced.

These diseases may cause serious health problems. Therefore, it is important to be protected by vaccine shots. Usually, the vaccines for all three diseases are combined and are given together as one shot. This is called the DTP vaccine. DTP vaccine is usually given 5 times before a child reaches age 7 years.

Every vaccine has risks as well as benefits. Most problems that happen after receiving vaccines are mild, but a few people will have a serious problem. While most infants and children under 7 years of age should get the DTP, a few should delay getting this vaccine and a few others should get the DT vaccine (diphtheria and tetanus vaccine) instead. Another tetanus and diphtheria vaccine (Td) is used to protect older children and adults. Tetanus vaccine (T) is still used by some doctors, but the combined Td vaccine is recommended by most experts.

This pamphlet tells you more about:

• The diseases diphtheria, tetanus, and pertussis
• The benefits of the vaccines
• The risks of the vaccines
• When your child should routinely get vaccines
• When your child should delay getting or not get the DTP vaccine
• What to look for and to do after the shot

What Are These Diseases?
Pertussis, sometimes called whooping cough, may be a mild or serious disease. It is very easily passed from one person to another. Pertussis can cause spells of coughing and choking that make it hard to eat, drink, or breathe. The coughing can last for several weeks.

The information on pertussis that follows is based on cases that were reported from doctors and health-care providers. In recent years, as many as 4,200 cases of pertussis have been reported yearly in the United States and outbreaks still occur. Many cases, including those with less serious illness, do not get reported.

Pertussis is most dangerous to babies (children less than 1 year old). Even with modern medical care, complications occur. About half of the babies reported to have pertussis are so sick that they must go into the hospital. As many as 16 out of 100 babies with pertussis get pneumonia, and as many as 2 out of 100 may have convulsions (seizures, fits, spasms, twitching, jerking, or staring spells). About 1 baby out of 200 has brain problems that may last all his or her life. About 1 out of every 200 babies with pertussis dies of it. Serious illness is less likely in older children and adults.

Diphtheria is a very serious disease. It can make a person unable to breathe, cause paralysis, or heart failure. About 1 out of every 10 people who get diphtheria dies of it.

Only a few cases of diphtheria were reported in the United States during the past few years. This is mostly because people have had shots to protect them.

Tetanus, sometimes called lockjaw, is a very serious disease that can occur after a cut or wound lets the germ into the body. Tetanus makes a person unable to open his or her mouth or swallow, and causes serious muscle spasms. People with tetanus usually have to stay in the hospital for a long time. In the United States, tetanus kills 3 out of every 10 people who get the disease. Since 1975, only 50 to 90 cases of tetanus have been reported each year.

Almost no cases occur in children or young adults because children and young adults have taken the shots and are usually protected.

What About the Vaccines and Their Benefits?
The vaccines to protect children younger than 7 years old against all 3 diseases are usually given together as one shot. This is called the DTP vaccine (Diphtheria, Tetanus, and Pertussis). Most children should get 5 DTP shots before they go to school. Most babies should get 3 DTP shots by 6 months of age.

Three or more DTP shots keep:

• 70 to 90 children out of 100 from getting pertussis if exposed to it, and usually protect the child through the elementary school years. The others who have had the DTP vaccine but get pertussis usually have a milder illness than if they had not had the vaccine.
• At least 85 children out of 100 from getting diphtheria for at least 10 years.
• At least 95 children out of 100 from getting tetanus for at least 10 years.

Pertussis vaccine should not be given to a few children. Other vaccines are available for these children and for adults:

• DT vaccine (Diphtheria and Tetanus) is given to children under age 7 years who should not receive pertussis vaccine.
• Td vaccine (Tetanus and diphtheria) is specially made for children age 7 years and older and for adults.

What Are the Risks of These Vaccines?
DTP
Most children have little or no problem from the DTP shot. Many children will have fever or soreness, swelling, and redness where the shot was given. Usually these problems are mild and last 1 to 2 days. Some children will be cranky, drowsy, or not want to eat during this time.

Less often - that is, following 1 DTP shot in 100 to 1 shot in 1,000 - a more serious problem can happen:

• Crying without stopping for 3 hours or longer
• A temperature of 105 degrees F or higher
• An unusual, high-pitched cry

Even less often - following 1 DTP shot in 1,750 - a child may have:

• A convulsion (seizures, fits, spasms, twitching, jerking, or staring spells), usually from high fever that may happen after the shot
• Shock-collapse (become blue or pale, limp, and not responsive)

Rarely, brain damage that lasts for the child's life has been reported after getting DTP. However, most experts now agree that DTP has not been shown to be a cause of brain damage. If DTP ever causes brain damage, then such an event would be very rare. There is no test that can tell in advance if your child will have any of these problems following DTP vaccination.

DT, Td, and T
DT, Td, and T vaccines cause few problems. They may cause mild fever or soreness, swelling, and redness where the shot was given. These problems usually last for 1 to 2 days, but this does not happen nearly as often as with DTP vaccine. Sometimes, adults who get these vaccines too often can have a lot of soreness and swelling where the shot was given.

There is a rare chance that other serious problems or even death could occur after getting DTP, Pertussis, DT, T, or Td. Such problems could happen after taking any medicine or after receiving any vaccine.

When Should Your Child Get the DTP Vaccines and Other Vaccines?
Below are all of the vaccines that most infants and children should get and the age when most experts suggest they should get each dose of vaccine.

Are the Benefits of the Vaccines Greater Than the Risks?
Yes, for almost all people.

Children, especially infants, who catch pertussis are often seriously ill. People with diphtheria or tetanus usually are seriously ill. Most people who have had 3 or more shots of DTP are protected from these diseases for many years. If children have the DTP shots but get pertussis, the illness is usually milder than if they had not had the shots. The number of children who have had a serious problem after receiving DTP is unknown, but is probably very small.

Experts believe that most children should receive DTP shots. If a child should not receive DTP, the child should usually receive DT. After reading this pamphlet and talking with your doctor or nurse, you can decide together what is best for your child.

When Should A Shot Be Delayed?
There are several reasons for a child to delay getting the DTP shot. If the child:

• Is sick with something more serious than a minor illness such as a common cold, delay the vaccination until your child is better.
• Has ever had a convulsion or other brain problem or seems not to be developing normally (until it is clear that your child is not getting worse or having more convulsions).

Such children should be carefully examined by a doctor before a decision is made.

If your child is sick or if you are not sure if a shot should be delayed, talk to your doctor or nurse. Then you can decide together what is best for your child.

When Should the DTP Vaccine NOT Be Given?
Your child should not get another DTP shot if any of the problems listed below happened after an earlier DTP and had no other obvious cause. Talk with your doctor or nurse about any of these problems.

• Serious problems of the brain within 7 days after getting DTP.
• Serious allergic problem (swelling in the mouth, throat, or face, or difficulty breathing) within a few hours after getting DTP. The presence of a brain problem that is getting worse, such as uncontrolled convulsions.

Many experts believe that a child should not get another DTP shot if any of the problems listed below happened after an earlier DTP shot and had no other obvious cause. However, for some children, the benefits outweigh the risks. Talk with your doctor or nurse about any of these problems.

• Temperature of 105 degrees F or higher within 2 days after getting DTP.
• Shock-collapse (becoming blue or pale, limp and not responsive) within 2 days after getting DTP.
• Convulsion within 3 days after getting DTP.
• Crying that cannot be stopped and which lasts for more than 3 hours at a time within the 2 days after getting DTP.

If you know or think that any of these problems happened after getting DTP, tell a doctor or nurse before that child receives another DTP or any other vaccine. If a child should not be given DTP, usually the child should get DT vaccine instead.

Should Pregnant Women Receive Td?
Babies born under unclean conditions to women who have no protection against tetanus have an increased risk of getting tetanus as newborns. This can be prevented by giving Td vaccine to women. Women who have not received Td or T earlier should be given the vaccine when they are pregnant.

Td and T vaccines are not known to cause special problems for pregnant women or their unborn babies. While doctors usually do not recommend giving any drugs or vaccines to pregnant women, a pregnant woman who needs Td vaccine should get it.

Which Children May Be More Likely to Have A Convulsion After Receiving DTP?
The chance of a child having a convulsion with fever after receiving DTP vaccine is up to 9 times greater if the child has had a convulsion before. It is about 3 times greater if the child's brother, sister, or parent has ever had a convulsion.

Most experts agree that unless the convulsion occurred within 3 days after getting DTP vaccine, children who have had a convulsion should still get the DTP vaccine. Also children who have a family member who has had a convulsion should get the DTP vaccine.

It is usually the fever that causes the convulsion. Most experts believe that convulsions with fever do not cause any permanent damage to the child.

Be sure to tell the doctor or nurse who is giving the shot about any history of convulsions. Talk with them about the medicines or other measures to reduce fever and soreness from the vaccines.

What to Look For and to Do After the Shot
Talk with the doctor or nurse who gives the shot about taking medicines or other measures to reduce fever and soreness from the vaccine.

This pamphlet lists the problems that may occur after receiving DTP or other shots for diphtheria, tetanus, or pertussis.

As with any serious medical problem, if the person has a serious or unusual problem after getting the vaccine, CALL A DOCTOR OR GET THE PERSON TO A DOCTOR PROMPTLY.

If you or your child does have a reaction to the vaccine, you can help your doctor by writing down exactly what happened.

Use this form or write on a piece of paper exactly what happened, what day it happened, and the time it happened.

Type of Vaccine and Date Received:__________________
Day and Time Problem Started:____________________
Problems:__________________

Have The Problem Reported
The Public Health Service is interested in finding out if any serious problems may be related to DTP, Pertussis, DT, T, or Td vaccines, especially those that occur within 4 weeks after the shot.

If you believe that the person receiving the vaccine had a serious problem or died because of the shot:

Call this number:

And ask the doctor or health department to report the problem on a Vaccine Adverse Event Report form.

If you think the problem was not reported, you should report the problem yourself. You can get the form by calling this toll-free number: 1-800-822-7967.

Get Information About Possible Help
A U.S. government program provides compensation for some persons injured by vaccines. For more information, call this toll-free number:

1-800-338-2382

Or contact:

The U.S. Claims Court
717 Madison Place, NW
Washington, DC 20005
(202) 633-7257

What Vaccines Does Your State Require?:
To protect as many children as possible from these diseases, all states require certain vaccines before the child goes to child-care or school. Ask your doctor or nurse what vaccines your state requires.

Addendum To "Diphtheria, Tetanus, and Pertussis: What You Need to Know"
What You Need To Know About the New Pertussis Vaccine
After the 1991 pamphlet "Diphtheria, Tetanus, and Pertussis: What You Need to Know" was prepared, a new pertussis vaccine became available for the fourth and fifth shots against diphtheria, tetanus, and pertussis. The information below provides up-to-date information about the new vaccine.

What Is the New Vaccine?
DTP vaccine is usually given 5 times before a child reaches age 7 years. Until now, pertussis vaccine has been made from killed whole pertussis cells and mixed with diphtheria and tetanus vaccines to make the whole-cell DTP shot. The new acellular pertussis vaccine, DTaP, is made of only a few parts of the pertussis cell and is also combined with diphtheria and tetanus vaccines.

When Should It Be Used ?
The fourth and fifth shots of the DTP vaccine series are usually given to children 15-18 months old and 4-6 years old. The DTaP vaccine can be used only for the fourth and fifth shots. Testing is now in progress to show that DTaP is safe and effective for the first three doses. Until these studies are completed, this vaccine cannot be considered for use for the first three doses of the vaccine series. Whole-cell DTP vaccine should still always be used for the first three shots, and can still be used for the fourth and fifth DTP shots, although most experts will prefer to use DTaP vaccine.

Compared with the DTP vaccine, after DTaP shots fewer children will be cranky or drowsy, have fever, or have soreness or swelling where the shot was given. Convulsions that occur after receiving DTP vaccine are usually caused by fever, so convulsions probably occur less often. Experts do not know whether unusual, more serious problems which have been reported after DTP vaccine (mentioned in the pamphlet) happen less often after DTaP shots than after DTP shots.

When Should the Vaccine Not Be Given?
If the health care provider determines that a whole-cell DTP shot should not be given, DTaP also should not be given. In that case, the child should usually get DT vaccine instead.

Vaccine Administration Record
The doctor or clinic may keep this record in your medical file or your child's medical file. They will record what vaccine was given, when the vaccine was given, the name of the company that made the vaccine, the vaccine's special lot number, the signature and title of the person who gave the vaccine, and the address where the vaccine was given

"I have read or have had explained to me the information in this pamphlet about diphtheria, tetanus (lockjaw), and pertussis (whooping cough) disease and DTP, Pertussis, DT, Td, and Tetanus vaccines. I have had a chance to ask questions that were answered to my satisfaction. I believe I understand the benefits and risks of the DTP, Pertussis, DT, Td, and Tetanus vaccines and ask that the vaccine checked below be given to me or to the person named below for whom I am authorized to make this request."

Vaccine to be given:

• DTP
• Pertussis
• DT
• Td
• Tetanus

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