diphtheria and tetanus toxoids and acellular pertussis vaccine, adsorbed (DTaP)
Certiva, Daptacel, Infanrix, Tripedia

Available forms

Injection: 6.7 Lf units diphtheria, 5 Lf units tetanus, and 46.8 mcg pertussis antigens per 0.5 ml in single-dose and 7.5-ml vials; 15 Lf units of inactivated diphtheria, 5 Lf units inactivated tetanus, and 10 mcg acellular pertussis antigens per 0.5- ml vials;15 Lf units of diphtheria toxoid, 6 Lf units tetanus toxoid, and 40 mcg pertussis toxoid per 0.5 ml in 7.5-ml vials; 25 Lf units of diphtheria toxoid, 10 Lf units tetanus toxoid, 25 mcg pertussis toxin, 25 mcg FHA, 8 mcg peractin per 0.5 ml in 0.5-ml vials

Indications and dosages
 Primary immunization. Children ages 6 weeks to 7 years: Give 0.5 ml I.M. 4 to 8 weeks apart for three doses and a fourth dose at least 6 months after the third dose. When using the Daptacel formulation, space the first three doses 6 to 8 weeks apart. The fourth dose should be at least 6 months after third dose.
 Booster immunization.   If Tripedia was used for the first four doses, a fifth dose is recommended at ages 4 to 6 before entering school. If fourth dose was given after age 4, a fifth dose isn’t needed.
 Certiva as a fourth dose is recommended at ages 15 to 20 months in children who received their first three doses as whole-cell DTP vaccine. A fifth dose is recommended at ages 4 to 6 in children who received four doses of whole-cell DTP vaccine or three doses of whole-cell vaccine followed by one dose of DTaP, unless the fourth dose was given after the fourth birthday.
 Infantrix is recommended as a fifth dose in children ages 4 to 6, before entering school, who received one dose or more of whole-cell DTP unless the fourth dose was given after the fourth birthday.
 If Daptacel is given as a first dose in the series, it should be used for all remaining doses. Daptacel may be used to complete the series in a child who has received the whole cell pertussis DTP.

Pharmacodynamics
Diphtheria, tetanus, and pertussis (whooping cough) prophylaxis: Vaccine promotes active immunity to diphtheria, tetanus, and pertussis by inducing production of antitoxin and antibodies.

Pharmacokinetics
Absorption: No information available.

Contraindications and precautions
Contraindicated in those who have had previous hypersensitivity or adverse reactions to any of the components of the vaccine. Contraindicated in immunosuppressed patients (not including HIV-infected patients) and in those on corticosteroid therapy or with history of seizures. Defer vaccination in patients with acute febrile illness. Children with neurologic disorders shouldn’t receive pertussis component. Also, children who exhibit neurologic signs after injection shouldn’t receive pertussis component in any succeeding injections. Give diphtheria and tetanus toxoids (called DT) instead.

Interactions
Drug-drug. Corticosteroids, immunosuppressants: May impair immune response to the toxoids and vaccine. Avoid elective immunization under these circumstances.

Adverse reactions
CNS: drowsiness,seizures,fever.
GI: vomiting, anorexia.
Skin: soreness, redness, swelling at injection site.
Other: hypersensitivity reactions, fretfulness, irritabilility, crying.

Effects on lab test results
None reported.

Overdose and treatment
No information available.

Special considerations
 ALERT Vaccine isn’t routinely given to people age 7 and older; it’s given only in special circumstances.
• Obtain history of allergies and reactions to immunizations, especially to pertussis vaccine.
• Have epinephrine solution 1:1,000 available to treat allergic reactions.
• Don’t use to treat active tetanus, diphtheria, or pertussis infections.
 ALERT DTaP products aren’t generically equivalent. Use vaccines from the same manufacturer for all vaccinations in the series whenever possible.
• Vaccine may be given at same time as trivalent oral polio vaccine and, if indicated, when patient receives vaccines against Haemophilus influenzae type b, measles, mumps, and rubella.
• Store under refrigeration.

Patient education
• Explain to parents that child may experience discomfort at injection site after immunization and that a nodule may develop there and persist for several weeks. Fever, upset stomach, or general malaise may also develop. Recommend acetaminophen liquid to relieve such discomfort.
• Tell parents to report worrisome reactions promptly.
• Stress importance of keeping scheduled appointments for subsequent doses. Full immunization requires a series of injections.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use