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Diphtheria and Diphtheria Toxoid

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Title: Diphtheria and Diphtheria Toxoid


1
  • Diphtheria and Diphtheria Toxoid

Epidemiology and Prevention of Vaccine-Preventable
Diseases National Immunization Program Centers
for Disease Control and Prevention
Revised January 2006
2
Note to presenters Images of vaccine-preventable
diseases are available from the Immunization
Action Coalition website at http//www.vaccineinfo
rmation.org/photos/index.asp
3
Diphtheria
  • Greek diphthera (leather hide)
  • Recognized by Hippocrates in 5th century BCE
  • Epidemics described in 6th century
  • C. diphtheriae described by Klebs in 1883
  • Toxoid developed in 1920s

4
Corynebacterium diphtheriae
  • Aerobic gram-positive bacillus
  • Toxin production occurs only when C. diphtheriae
    infected by virus (phage) carrying tox gene
  • If isolated, must be distinguished from normal
    diphtheroid

5
Diphtheria Clinical Features
  • Incubation period 2-5 days (range, 1-10 days)
  • May involve any mucous membrane
  • Classified based on site of infection
  • anterior nasal
  • pharyngeal and tonsillar
  • laryngeal
  • cutaneous
  • ocular
  • genital

6
Pharyngeal and Tonsillar Diphtheria
  • Insidious onset of exudative pharyngitis
  • Exudate spreads within 2-3 days and may form
    adherent membrane
  • Membrane may cause respiratory obstruction
  • Fever usually not high but patient appears toxic

7
Diphtheria Complications
  • Most attributable to toxin
  • Severity generally related to extent of local
    disease
  • Most common complications are myocarditis and
    neuritis
  • Death occurs in 5-10 for respiratory disease

8
Diphtheria Antitoxin
  • Produced in horses
  • First used in the U.S. in 1891
  • Used only for treatment of diphtheria
  • Neutralizes only unbound toxin

9
Diphtheria Epidemiology
  • Reservoir Human carriers Usually
    asymptomatic
  • Transmission Respiratory Skin and
    fomites rarely
  • Temporal pattern Winter and spring
  • Communicability Up to several weeks without
    antibiotics

10
Diphtheria - United States, 1940-2005
Year
11
Diphtheria - United States, 1980-2005
Year
12
Diphtheria United States, 1980-2004Age
Distribution of Reported Cases
N53
13
DTaP, DT, and Td
Diphtheria 7-8 Lf units 2-2.5 Lf units
Tetanus 5-12.5 Lf units 5 Lf units
DTaP, DT Td, Tdap (adult)
DTaP and pediatric DT used through age 6 years.
Adult Td for persons 7 years and older. Tdap for
persons 10-18 years (Boostrix) or 11-64 years
(Adacel)
14
Diphtheria Toxoid
  • Formalin-inactivated diphtheria toxin
  • Schedule Three or four doses booster
    Booster every 10 years
  • Efficacy Approximately 95
  • Duration Approximately 10 years
  • Should be administered with tetanus toxoid as
    DTaP, DT, Td, or Tdap

15
Routine DTaP Primary Vaccination Schedule
Dose Primary 1 Primary 2 Primary 3 Primary 4
Age 2 months 4 months 6 months 15-18 months
Interval --- 4 wks 4 wks 6 mos
16
Children Who Receive DT
  • The number of doses of DT needed to complete the
    series depends on the childs age at the first
    dose
  • if first dose given at lt12 months of age, 4 doses
    are recommended
  • if first dose given at gt12 months, 3 doses
    complete the primary series

17
Routine DTaP ScheduleChildren lt7 years of age
Booster Doses
  • 4-6 years of age, before entering school
  • 11-12 years of age if 5 years since last dose
    (Tdap)
  • Every 10 years thereafter (Td)

18
Routine Td ScheduleUnvaccinated Persons 7 Years
of Age
Booster dose every 10 years
ACIP recommends that one of these doses
(preferably the first) be administered as Tdap
19
Diphtheria and Tetanus ToxoidsAdverse Reactions
  • Local reactions (erythema, induration)
  • Exaggerated local reactions (Arthus-type)
  • Fever and systemic symptoms not common
  • Severe systemic reactions rare

20
Diphtheria and Tetanus ToxoidsContraindications
and Precautions
  • Severe allergic reaction to vaccine component or
    following a prior dose
  • Moderate or severe acute illness

21
National Immunization ProgramContact Information
  • Telephone 800.CDC.INFO
  • Email nipinfo_at_cdc.gov
  • Website www.cdc.gov/nip
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