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DTaP immunization

DTaP is an immunization against three bacteria: Diphtheria, Tetanus andPertussis. The preceding the pertussis stands for acellular, and refers to the way in which the vaccine is made. The American Academy of Pediatrics recommends immunizing with DTaP at 2mo., 4mo., 6 mo., 12-18 mo., and 4-6 years, for a total of 5 shots. After this, a Td (tetanus, diphtheria) booster is given every 10 years throughout life.

Diphtheria is rarely seen today, although there have been epidemics in Russia, the Ukraine, and the central Asian republics since 1990. As we are becoming a global community, it is all the more important to continue active immunization programs even in the face of disappearance of these infections in the United States.

In classic diphtheria, the infection is localized to the tonsils, nose and throat. Small ulcers will form around the nose and upper lip. In the throat a membrane (a confluent thin covering) forms over the tonsils and extends into the throat. This membrane can obstruct the airway and cause suffocation. Heart complications occur in 10-25% of people and cause 50% of the deaths from diphtheria. Nervous system complications may also occur, and include weakness of the throat muscles, visual changes including blurred vision, and extremity weakness.

Diphtheria is spread by droplets from coughing and sneezing. In areas where diphtheria is present, such as Russia, approximately 3-5% of people carry diphtheria in their nose and throat, and can spread it to others.

Treatment should be administered even before culture results are available because the course may deteriorate rapidly. A single dose of antitoxin is given intravenously. Antibiotics are given in addition to antitoxin, penicillin or erythromycin, for a 14 day course.

The cornerstone of prevention is immunization. In exposed household contacts, regardless of immunization status, they need to be given prophylactic antibiotics for 7 to 10 days. If it has been 5 years since the last booster, a shot of tetanus/diphtheria should be given. If there are young children or others in the house who have not received the full vaccination schedule, they should receive a vaccination.

Carriers should be treated with antibiotics, and if they have not had a full series of shots, they should get an immunization. Follow-up cultures of the nose and throat should be obtained 2 weeks after completing the antibiotic course to assure elimination of carriage.

Tetanus (lockjaw) is a neurologic disease manifested by severe muscular spasms of the jaw caused by a toxin–tetanospasmin. The bacterium responsible for causing tetanus is Clostridium tetani, which is a normal inhabitant of soil and of the intestinal tract of various animals. It is ubiquitous in the environment, especially where animal feces are present. The bacteria gains access by open wounds that have been contaminated with saliva, soil, or feces. Most cases are associated with a penetrating wound that has been inflicted by a dirty object, such as a nail, splinter, or fragment of glass. Tetanus also occurs in newborn babies, where the bacteria gains access via the umbilical cord in unimmunized mothers. Approximately 500,00 babies die each year from neonatal tetanus, with 80% of these occurring in 12 tropical Asian and African countries. There are about 50 cases of tetanus per year in the United States.

The symptoms of tetanus include masseter muscle spasm (lockjaw), headache, restlessness, and irritability. In addition, difficulty swallowing and neck muscle spasms occur. The muscle spasms will spread to other muscles of the body resulting in repetitive, sudden muscular contraction causing boardlike rigidity of the entire body.

The following complications may arise from the sustained muscle spasms: aspiration pneumonia, lacerations of the tongue and mouth, and bone fractures. Spasm of the laryngeal muscles may lead to airway obstruction.

Treatment requires prompt administration of human tetanus immune globulin (TIG) and antibiotics, penicillin or erythromycin. Surgery is often needed to clean the wound of any foreign debris that may have contributed to providing the growth conditions for Clostridium tetani. Muscle relaxants are important for comfort and control of the muscle spasms, with valium being the most frequently used. Once the patient has recovered, it is of vital importance to immunize with tetanus toxoid as infection will not result in the production of toxin-neutralizing antibodies.

Tetanus is a preventable disease. Proper immunization is vital. The following injuries need prompt evaluation by a physician:

  • injuries that result in wounds that have potentially been contaminated by soil, feces, or saliva
  • crush injuries

puncture injuries from dirty nails or fragments of glass

Assessment of the date of the last tetanus shot or booster is imperative.