The DT vaccine is a combination vaccine against diphtheria and tetanus. It is intended for use in children less than 7 years old who cannot receive the DTaP vaccine because of a reaction to the pertussis portion of that vaccine. (Children older than 7 years need the adult form of the vaccine, Td, which has a lesser dose of the diphtheria portion). We hardly ever use this vaccine because virtually all children can receive the DTaP vaccine, and because it is very important to continue to immunize infants against pertussis.
Diseases
Diphtheria is a severe bacterial infection caused by Corynebacterium diphtheriae. It infects the nose and throat; the disease is actually caused by a toxin that the bacteria produce. The infection is spread easily from person to person. The infection may make it hard to breathe and swallow, but more importantly the toxin also attacks the heart, kidneys, and nerves causing paralysis, heart failure, and death. In the 1920’s in the United States, about 150,000 people a year got diphtheria and about 15,000 of them died. The disease has almost disappeared since the introduction of the vaccine in the early 1940’s; however, outbreaks still occur when immunization rates fall. There were several severe outbreaks in Eastern Europe and Russia in the 1990’s. Interestingly, the vaccine works by making the immune system attack and inactivate the toxin produced by the bacteria; it does not make the body attack the germ itself!
Tetanusis a lethal infection caused by a common bacteria that lives in the soil, Clostridium tetani. People catch tetanus not from other people but through a break in the skin (cuts, scratches, puncture wounds, bites, burns) that is contaminated with dirt containing the spores of the bacteria. Once inside the body, the bacteria produce a lethal toxin that paralyzes muscles, including the jaw (thus the term “lockjaw’); it also paralyzes the chest muscles making it impossible to breathe and the heart, leading to death. It causes muscle contractions so strong and violent that it can break the bones of children. Young children and the elderly are most susceptible to the disease. Since the bacteria live in the soil, tetanus continues to be a threat and cannot be eradicated. Teenagers and adults need a booster shot (Td) every 10 years to remain protected. The vaccine works by making the immune system attack and inactivate the toxin produced by the bacteria. The vaccine was first produced in the 1920’s and became a routinely used in children in the 1940’s. At that time, there were about 500 cases of tetanus a year; this has dropped to around 50 now, and about 30% of people who get tetanus die from it.
Schedule
The DT vaccine would be given at the same ages as DTaP, in place of that vaccine.
How it is given
The vaccine is injected into the thigh or arm muscle. It is safe and effective to give DT along with other vaccines the same day, and it is safe and effective to give multiple injections in the same arm or leg.
Side effects
The vaccine causes few side effects. It may cause some soreness at the injection site for 1-2 days; it can also cause a slight fever.
Risks vs. benefits
The risks of the vaccine are small, with the side effects noted above, and no one has ever died from the vaccine. Diphtheria outbreaks are occurring in other countries when immunization rates fall, and tetanus is a continual possibility since it comes from bacteria living in the soil. Pertussis is a far greater threat, however, and children should receive the DTaP vaccine instead if at all possible.
Contraindications
Someone who has had a severe allergic reaction to DT vaccine should not get another dose. A child who is moderately or severely ill should probably delay the vaccination until he or she has recovered from the illness.
Combination vaccines
The DT vaccine is not used in any combination vaccines in the United States.
Brands/manufacturers
DT (Sanofi-Aventis); the single dose vial does not contain thimersol (mercury); the multi-dose vial does contain thimersol as a preservative
