Tdap (DTP) is a combined vaccine creating an active immune protection against diphtheria, pertussis and tetanus. It is effective in the absolute majority of patients. In case of the right and full primary vaccination, the immunity is protected against diphtheria and tetanus for 10 years, thus, a revaccination should be done every decade. Immunity against whooping cough lasts for 5-7 years.
Although a timely revaccination is as important as the primary vaccination, not all patients receive it. This is explained by the fact that school-age children, adolescents and adults relatively often have vaccinal reactions, as they are not offered special combined vaccines with an acellular (cell-free) pertussis component. The introduction of an inactivated whole-cell pertussis component causes most of these reactions.
Tdap is always introduced intramuscularly. Before the introduction of any Tdap vaccine with a whole-cell pertussis component, it is advisable to take antifebrile medication. This prevents sharp rise in temperature and helps to avoid febrile seizures (caused by high temperature) in children. NSAIDs administered for this purpose have both anti-inflammatory and analgesic effect, which is very useful, since they are able to prevent expressed pain at the injection site and any possible occurrence of edema.
The doctor and the parents can reduce the likelihood of unpleasant reactions, if they make proper preparations. If a child has any allergy, for example atopic dermatitis, he should take an antihistaminic drug before the vaccination. The intake of any antihistaminic and anti-inflammatory drugs will not affect the vaccination efficiency or reduce the immunity capacities.
The Schema of Prepare to Tdap Administration
- Day -2, -1. Children with allergies should take prescribed by physician antihistaminic drugs in the usual dose.
- Day 0. Back home after the vaccination you should give your child an antifebrile drug in the form of rectal suppositories, which will prevent pain, edema, whims and anxiety. If the temperature rises, you can administer one more suppository. During night feedings, you should also control the temperature and, if necessary, insert another suppository. Do not forget about anti-allergic drugs.
- Day 1. Measure the temperature. Optionally, insert suppositories in the morning, in the afternoon and at night. Continue to give the baby antihistaminic drugs.
- Day 2. Control the temperature and insert antifebrile suppository only if the temperature is high. Continue to give the baby antihistaminic drugs.
- Day 3. In case of the introduction of an inactivated vaccine, the baby is unlikely to develop adverse reactions such as high temperature and inflammation at the injection site on the third day after the vaccination. The temperature rise later on the third day is unlikely to be a vaccination reaction. In this case, you’d better consult your pediatrician, he is sure to find the true reason (it can be teeth cutting, respiratory viral infection, etc.).
There are several types of contradictions to Tdap vaccine: true, false, temporary. True contraindications are acute diseases, an allergy to any component of the vaccine, pronounced immunodeficiency that prevents from generating an immune response. If the child is observed with a progressing CNS pathology or afebrile seizures, it is better to use TD vaccine that lacks the pertussis component.
Some contraindications are temporary. Thus, a child with diathesis can be vaccinated when the flare-up is over, and patient with ARD can be vaccinated after the recovery. Note that, for example, in the US ARD is not considered a contraindication, children are vaccinated despite the slight fever, cough or rhinitis.
Febrile seizures triggered by high temperatures of any genesis are neither contradiction to the vaccination. The child simply needs to be prepared for vaccination. Febrile seizures in response to the previous introduction of Tdap are a true contradiction.
A large percentage of babies on the territory of CIS are diagnosed with "perinatal encephalopathy", referring to vague, not marked in the world classification, often falling within the norms abnormalities of the central nervous system. "Perinatal encephalopathy" is one of the most common false contraindications to vaccinations. Most often, the symptoms disappear or diminish by the time of the first Tdap administration, but if parents worry, they should consult a neurologist before the vaccination.
Other common false contraindications to Tdap are prematurity, antibiotic intake, various allergic manifestations (except allergies to vaccine components), as well as data from the family history of allergies, seizures, unusual reactions to Tdap vaccination in the child's relatives. True contraindications to Tdap vaccination are allergic or neurologic adverse reaction after a previous dose.
The paradox is that an occurrence of a minor side effect is actually a good sign. Thus, the body makes you know that the vaccine works, and the immunity is actively forming an adequate response. However, if no side effects are observed, it does not mean that everything goes wrong, the vaccine is not effective or the immunity does not work. Finally, parents and doctors tried to achieve this effect selecting the right time of vaccination, giving the baby proper medications and providing special care.
A reaction at the injection site occur in 15-25 % of immunized children, both prepared and unprepared to vaccination, redness (1-2 %) and swelling (1-2 %) are explained by the local immune response in the site of injection or an adjuvant impact. Local inflammation may cause pain (15 %) that is manifested in crying, whining and protecting the injection site.
Common reactions occur in 20 % of cases in both prepared and unprepared patients. The most common reactions (in up to 30 % of cases) are high temperature, nausea and vomiting, restlessness or weakness, diarrhea, loss of appetite.
The introduction of Tdap as well as other vaccines may cause allergic reactions. This may be urticaria, Kwinke swelling, anaphylactic shock. Such reactions are in the first place due to the child’s peculiarities, allergic reactions to specific vaccine’s components, their content in the vaccine and, quite rare, to any violation of the vaccination procedure.