Diseases, Disorders information

Again, tetanus toxoid comes in a variety of vaccine formulations and to prevent tetanus we really must pay attention to wound care. Cleaning the wound, making sure you debride any devitalized tissue and taking out any foreign body.
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Finally, you put the D and T together with a pertussis component and you get DTaP vaccine, the acellular pertussis component, and that includes various components of Bordetella pertussis. Including possibly pertussis toxin, filamentous hemagglutinin, pertactin (pertucin?) fimbriae and a variety of combinations of these which we will get to. The main difference with DTaP vaccine and whole cell DTP vaccine is the decreased endotoxin content in the acellular formulation. This is given in a five day series, two for six months, 12-18 months and finally at 4-6 years of age. You do not give pertussis vaccines, at this point, at seven years of age and older. Only less than seven years of age. The efficacy of the DTaP vaccine is similar to DTP vaccine. About 80-95% and the reaction is lower rate to the common reactions compared to the DTP vaccine. Mostly because of the decreased endotoxin content. The DTaP vaccines are shown in this slide. These are all the FDA-approved vaccines. They are all different. They have different names, different manufacturers and different compositions; a variety of different antigens that are produced in different ways, they are in the vaccine in different quantities. For purposes of taking the test, these are all similar in terms of reactagenicity. There is no meaningful clinical differences between the reactagenicity and there are no meaningful differences between the efficacies of these vaccines and immunogenicities of these vaccines for test taking purposes. There is no difference in efficacy. So you really don’t have to spend too much time on the names and all that. But you do need to know that they are all different and they have different composition. The FDA has approved these for different doses. Really, from a practical standpoint, you can use any of these vaccines at any time. And these vaccines are interchangeable, although it is preferable for at least the first three doses to use the same vaccine, but not required.
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The relative contraindications to pertussis vaccine are shown in this slide and this is different from an absolute contraindication. Pertussis, as you know, can be a very severe disease. So depending on a risk of a subject to pertussis and the complications that they could get from the disease, you need to weigh the risks and benefits. But prior vaccine reaction is a relative contraindication. That’s encephalopathy within seven days, a seizure within three days, persistent crying for three or more hours, collapse state or hypotonic hypo-responsive episode, fever greater than or equal to 40.5 C or an anaphylactic reaction. These are relative contraindications to further vaccination with any pertussis component vaccine. Anybody with a known or suspected progressive neurologic disorder or recent seizures. If you give the vaccine it may result in fever. Fever lowers the seizure threshold, this may induce the seizure and it may confuse the clinical picture. So anybody with those conditions or a known or suspected neurologic condition that predisposes to seizures or neurologic deterioration – the common example of that is tuberous sclerosis, where somebody may have tuberous sclerosis and may not show any signs or symptoms but you know that they are at risk for developing them – giving the vaccine may result in lowering the seizure threshold and then you are not sure. Was it the vaccine? Was it the disease? So you need to think about that.