* Blue = For age < 7
* Orange = For age ≥ 7
|
Comparing 1 dose = 0.5 ml each |
Diphtheria Toxoid |
Tetanus Toxoid |
Alumiunum |
Thiomersal |
Pregnancy |
Remarks |
|
Diphtheria and Tetanus Vaccine Adsorbed (Pediatric) Available in PKK Keningau |
≤ 25 Lf (≥ 30 IU) |
≥ 5 Lf (≥ 40 IU) |
Al+++ ≤ 1.25 mg |
0.005% |
Not mentioned in product leaflet |
·
Recommended for below 7
years old ·
For 7 years old and older, a special DT vaccine, containing a reduced
amount of diphtheria toxoid is recommended. |
|
Hexaxim DTaP-
IPV-HB-Hib Available in PKK Keningau |
≥ 20 IU |
≥ 40 IU |
Al(OH)3
0.6 mg Al3+ |
Not stated |
Not applicable. Not intended for administration in
women of child-bearing age |
For primary and booster vaccination of hose 6 weeks
to 24 months of age. |
|
Adsorbed DT Vaccine (Malaysia) |
20 Lf |
7.5 Lf |
Alumimium phosphate
1.5 mg |
0.05 mg |
Not applicable. |
For below 7 years old |
|
TDVAX™ Td (for age 7
and above in USA) |
2 Lf |
2 Lf |
Less than 0.53 mg aluminium adjuvant |
Trace amount, with ≤ 0.3 mcg mercury / dose |
Animal
reproduction studies have not been conducted with MassBiologics’ TDVAX. It is
also not known whether MassBiologics’ TDVAX can cause fetal harm when
administered to a pregnant woman or can affect reproduction capacity.
MassBiologics’ TDVAX should be given to a pregnant woman only if clearly
needed. |
Td (for age 7
and above in USA) |
|
Boostrix Tdap Agihan Khas JKNS |
≥ 2 IU (2.5 Lf) |
≥ 20 IU (5 Lf) |
Al(OH)3
0.3 mg Al3+ AlPO4
0.2 mg Al3+ |
Not stated |
·
The use of Boostrix may be considered during the third trimester of
pregnancy. ·
Safety data from a prospective observational study where Boostrix was
administered to pregnant women during the third trimester (793 pregnancy
outcomes) as well as data from post-marketing surveillance where pregnant
women were exposed to Boostrix or to Boostrix Polio (dTpa-IPV vaccine) have
shown no vaccine related adverse effect on pregnancy or on the health of the
foetus/newborn child. ·
Human data from prospective clinical studies on the use of Boostrix
during the first and second trimester of pregnancy are not available. ·
Limited data indicate that maternal antibodies may reduce the
magnitude of the immune response to some vaccines in infants born from
mothers vaccinated with Boostrix during pregnancy. The clinical relevance of
this observation is unknown. ·
Animal studies do not indicate direct or indirect harmful effects
with respect to pregnancy, embryonal/foetal development, parturition or
post-natal development. ·
Boostrix should only be used during pregnancy when the possible
advantages outweigh the possible risks for the foetus. |
For booster vaccination against diphtheria, tetanus
and pertussis for age 4 years and above. |
|
https://www.who.int/vaccine_safety/initiative/tools/DTP_vaccine_rates_information_sheet.pdf INFORMATION
SHEET OBSERVED RATE OF VACCINE REACTIONS DIPHTHERIA, PERTUSSIS, TETANUS
VACCINES (WHO, 2014) |
Diphtheria
toxoid - Diphtheria toxoid is prepared by formalin inactivation of diphtheria
toxin. Usually it is available as a preparation adsorbed with aluminium
hydroxide or phosphate and combined with other toxoids or vaccine antigens.
The potency of diphtheria vaccine used for the immunization of children
should not be less than 30 IU per single human dose, while for adults; the
potency is about a third of the dose for children. Monovalent single antigen
diphtheria toxoid is currently commercially unavailable. Tetanus
toxoid - Tetanus toxoid is a preparation of formalin inactivated toxin. The
toxoid is available adsorbed with aluminium phosphate or hydroxide, alone or
in combination with other toxoids or vaccines. The potency of tetanus toxoid,
expressed in International Units, varies widely according to the preparation
and the manufacturer, but WHO stipulates the potency of tetanus vaccine used
for the immunization of children should not be less than 40 IU per single
human dose. The minimum potency specification for tetanus vaccine intended
for booster immunization of older children and adults may be lower and should
be approved by the National Regulatory Authority (NRA). Single antigen
adsorbed tetanus toxoid is available with a toxoid content of 2 to 10 Lf/dose Diphtheria
and Tetanus (DT and Td) toxoid combination: DT vaccine used for primary
immunisation and boosting in children contains 6.7-25Lf of diphtheria toxoid
and 5 – 7.5 Lf of tetanus toxoid per dose. An adult combination, Td, is used
for boosting and primary immunisation in adolescents and adults and contains
a lower dose of diphtheria (less than 2 Lf/dose) but a similar dose of
tetanus toxoid |
|
UptoDate: Tetanus-diphtheria toxoid
vaccination in adults |
·
In the
United States, a diphtheria-tetanus toxoid (DT and Td) or diphtheria toxoid-tetanus toxoid-acellular pertussis
vaccine (DTaP
and Tdap; Adacel or Boostrix) vaccine 0.5 mL intramuscularly (IM) is
recommended every 10 years for all adults with complete prior immunization
against tetanus and diphtheria [2,4,5]. ·
At
least one of those doses should be with Tdap in adults aged 19 years and
older who had not received Tdap previously. ·
When
indicated, Tdap should be administered regardless of the interval since the
last dose of Td. ·
Subsequently,
booster doses with either Td or Tdap can be resumed 10 years later. |
|
USA CDC 2021 |
·
If a
tetanus-toxoid-containing vaccine is indicated for a pregnant woman, use
Tdap. ·
Pregnancy:
1 dose Tdap during each pregnancy, preferably in early part of gestational
weeks 27 to 36. |
|
UptoDate: Immunizations during
Pregnancy |
Vaccination with the tetanus
toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) is
routinely recommended during pregnancy [3]. Pregnant women who had not previously been
fully vaccinated against tetanus and diphtheria should also receive a tetanus
and diphtheria toxoid (Td) series. |
|
UptoDate:
Diphtheria and tetanus toxoid vaccines (DT [age <7 years] and Td [age ≥7
years]): Drug information |
Td vaccines (eg, TDVax, Tenivac) are for use in patients ≥7
years of age; DT vaccines (generics) are for use in pediatric patients 6
weeks to <7 years of age. Td vaccines contain less diphtheria toxoid than
DT vaccines; the vaccines are not interchangeable. b Tetanus toxoid in this chart refers to a
tetanus toxoid-containing vaccine. ·
For
children <7 years of age, DTaP (DT, if pertussis vaccine contraindicated)
is recommended. ·
For
children 7 to 10 years of age who are not fully immunized against pertussis,
diphtheria, or tetanus, Tdap should be used (followed by completion of
catch-up series). ·
Tdap is
preferred in patients ≥11 years of age if the patient has not previously been
vaccinated with Tdap, if Tdap history is unknown, or if the patient is
pregnant. ·
In
patients who have previously been vaccinated with Tdap, either Td or Tdap may
be used. In general, maternal use of inactivated
vaccines is not associated with increased risks to the fetus (ACIP [Kroger
2021]). Diphtheria toxoid and tetanus toxoid vaccines may be used during
pregnancy (CDC/ACIP [Liang 2018]). The Advisory Committee on Immunization
Practices (ACIP) recommends a single Tdap vaccination during each pregnancy;
ideally early in the period between 27 and 36 weeks' gestation to maximize
passive antibody transfer to the fetus. Pregnant females who are not
immunized or are only partially immunized should complete the primary series
with Td or Tdap. Tetanus immune globulin and a tetanus toxoid containing
vaccine are recommended by the ACIP as part of the standard wound management
to prevent tetanus in pregnant females; the use of a tetanus-toxoid
containing vaccine during pregnancy (with preference given to Tdap) is
recommended for wound management if ≥5 years have passed since the last Td
vaccination (CDC/ACIP [Havers 2020]); CDC/ACIP [Liang 2018]). |
|
CDC: Tdap Vaccine Safety for Mother and Infant |
Pregnant women have been getting
both tetanus and diphtheria toxoids (Td) and tetanus toxoid (TT) vaccines
worldwide since the 1960s to prevent neonatal tetanus. Td and TT vaccines
administered during pregnancy have not been shown to harm either the mother
or baby / fetus. |
|
American
College of Obstetricians and Gynaegologists: Update on Immunization and Pregnancy: Tetanus, Diphtheria,
and Pertussis Vaccination |
In 2013, the Advisory Committee on
Immunization Practices published its updated recommendation that a dose of
tetanus toxoid, reduced
diphtheria toxoid, and acellular pertussis (Tdap) should be administered during each pregnancy,
irrespective of the prior history of receiving Tdap. The recommended timing
for maternal Tdap vaccination is between 27 weeks and 36 weeks of gestation.
To maximize the maternal antibody response and passive antibody transfer and levels
in the newborn, vaccination as early as possible in the
27–36-weeks-of-gestation window is recommended. However, the Tdap vaccine may be safely given at
any time during pregnancy if needed for wound management, pertussis
outbreaks, or other extenuating circumstances. There is no evidence
of adverse fetal effects from vaccinating pregnant women with an inactivated
virus or bacterial vaccine or toxoid, and a growing body of robust data
demonstrate safety of such use. A pregnant woman should not be revaccinated with Tdap in
the same pregnancy if she received the vaccine in the first or second
trimester. |
Conclusion:
·
Only vaccines with reduced diphtheria component are
recommended in adults (age 7 and above) and pregnancy.
·
Generally when comparing diphtheria/tetanus-covering vaccine,
the tetanus toxoid component is similar, while the diphtheria toxoid content is
about 3-15 times higher in < 7 years old formulation.
·
No information or recommendation can be found regarding use
of paediatrics DT vaccine in population 7 years old and above.
·
No information can be found on the potential impact if
population 7 years old and above given extra diphtheria toxoid.
Useful References / Further Reading:
All
information accessed on 19 May 2021 [J. Ho]
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