diphtheria and tetanus toxoids vaccine

Generic Name: diphtheria and tetanus toxoids vaccine (DT, pediatric) (dif THEER ee a TET a nus TOX oids)
Brand Name: Diphtheria-Tetanus Toxoids, Pediatric (DT), Diphtheria-Tetanus Toxoids, Pediatric (DT)

What is diphtheria and tetanus toxoids vaccine?

Diphtheria and tetanus are serious diseases caused by bacteria.

Diphtheria causes a thick coating in the nose, throat, and airways. It can lead to breathing problems, paralysis, heart failure, or death.

Tetanus (lockjaw) causes painful tightening of the muscles, usually all over the body. It can lead to "locking" of the jaw so the victim cannot open the mouth or swallow. Tetanus leads to death in about 1 out of 10 cases.

Diphtheria is spread from person to person. Tetanus enters the body through a cut or wound.

The diphtheria and tetanus toxoids vaccine (also called DT) is used to help prevent these diseases in children who are ages 6 weeks to 6 years old, before the child has reached his or her 7th birthday.

This vaccine works by exposing your child to a small dose of the bacteria or a protein from the bacteria, which causes the body to develop immunity to the disease. This vaccine will not treat an active infection that has already developed in the body.

Like any vaccine, the diphtheria and tetanus toxoids vaccine may not provide protection from disease in every person.

What is the most important information I should know about this vaccine?

The diphtheria and tetanus toxoids vaccine is given in a series of shots. The first shot is usually given when the child is 2 months old. The booster shots are then given at 4 months, 6 months, and 12 to 18 months of age. A fifth booster dose is given between 4 and 6 years of age.

Your child's booster schedule may be different from these guidelines. Follow your doctor's instructions or the schedule recommended by your local health department.

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The pediatric version of this vaccine (DT) should not be given to anyone over the age of 6 years old. Another vaccine is available for use in older children and adults.

Be sure your child receives all recommended doses of this vaccine. Your child may not be fully protected against disease if he or she does not receive the full series.

Your child can still receive a vaccine if he or she has a minor cold. In the case of a more severe illness with a fever or any type of infection, wait until the child gets better before receiving this vaccine.

Your child should not receive a booster vaccine if he or she had a life-threatening allergic reaction after the first shot.

Keep track of any and all side effects your child has after receiving this vaccine. When the child receives a booster dose, you will need to tell the doctor if the previous shot caused any side effects.

Becoming infected with diphtheria or tetanus is much more dangerous to your child's health than receiving this vaccine. However, like any medicine, this vaccine can cause side effects but the risk of serious side effects is extremely low.

What should I discuss with my healthcare provider before receiving this vaccine?

Your child should not receive this vaccine if the child has:

  • untreated or uncontrolled epilepsy or other seizure disorder; or

  • if the child has received cancer chemotherapy or radiation treatment in the past 3 months.

Your child may not be able to receive this vaccine if he or she has ever received a similar vaccine that caused any of the following:

  • a very high fever (over 104 degrees);

  • a neurologic disorder or disease affecting the brain;

  • excessive crying for 3 hours or longer;

  • fainting or going into shock;

  • Guillain-Barré syndrome (within 6 weeks after receiving a vaccine);

  • seizure (convulsions); or

  • a severe skin reaction.

If your child has any of these other conditions, this vaccine may need to be postponed or not given at all:

  • a bleeding or blood clotting disorder such as hemophilia or easy bruising;

  • a history of seizures;

  • a neurologic disorder or disease affecting the brain (or if this was a reaction to a previous vaccine);

  • an allergy to latex rubber;

  • a weak immune system caused by disease, bone marrow transplant, or by using certain medicines or receiving cancer treatments; or

  • if the child is taking a blood thinner such as warfarin (Coumadin).

Your child can still receive a vaccine if he or she has a minor cold. In the case of a more severe illness with a fever or any type of infection, wait until the child gets better before receiving this vaccine.

The pediatric version of this vaccine (DT) should not be given to anyone over the age of 6 years old. Another vaccine is available for use in older children and adults.

How is this vaccine given?

This vaccine is injected into a muscle. Your child will receive this injection in a doctor's office or clinic setting.

The diphtheria and tetanus toxoids vaccine is given in a series of shots. The first shot is usually given when the child is 2 months old. The booster shots are given at 4 months, 6 months, and 12 to 18 months of age. A fifth booster dose is then given between 4 and 6 years of age. Your child's booster schedule may be different from these guidelines. Follow your doctor's instructions or the schedule recommended by your local health department.

Your doctor may recommend treating fever and pain with an aspirin-free pain reliever such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil, and others) when the shot is given and for the next 24 hours. Follow the label directions or your doctor's instructions about how much of this medicine to give your child.

It is especially important to prevent fever from occurring in a child who has a seizure disorder such as epilepsy.

What happens if I miss a dose?

Contact your doctor if you will miss a booster dose or if you get behind schedule. The next dose should be given as soon as possible. There is no need to start over.

Be sure your child receives all recommended doses of this vaccine. Your child may not be fully protected against disease if he or she does not receive the full series.

What happens if I overdose?

An overdose of this vaccine is unlikely to occur.

What should I avoid before or after receiving this vaccine?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

This vaccine side effects

Your child should not receive a booster vaccine if he or she had a life-threatening allergic reaction after the first shot.

Keep track of any and all side effects your child has after receiving this vaccine. When the child receives a booster dose, you will need to tell the doctor if the previous shots caused any side effects.

Becoming infected with diphtheria or tetanus is much more dangerous to your child's health than receiving this vaccine. However, like any medicine, this vaccine can cause side effects but the risk of serious side effects is extremely low.

Get emergency medical help if your child has any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if the child has a serious side effect such as:

  • extreme drowsiness, fainting;

  • severe headache or vomiting;

  • fussiness, irritability, crying for an hour or longer;

  • confusion, seizure (black-out or convulsions); or

  • high fever.

Less serious side effects include:

  • redness, pain, tenderness, swelling, or a hard lump where the shot was given;

  • mild fever;

  • mild fussiness or crying;

  • joint pain, body aches;

  • mild drowsiness; or

  • mild vomiting.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report vaccine side effects to the US Department of Health and Human Services at 1-800-822-7967.

See also: Side effects (in more detail)

Diphtheria and tetanus toxoids vaccine dosing information

Usual Pediatric Dose for Diphtheria Prophylaxis:

DT (pediatric) formulation:
Primary Immunization:
6 weeks to 1 year: Three doses of 0.5 mL IM at least 4 weeks apart followed by a fourth dose 6 to 12 months after the third dose. Preterm infants should be vaccinated according to their chronological age from birth.

1 to 6 years: Two 0.5 mL IM doses given at least 4 weeks apart followed by a fourth dose 6 to 12 months after the third dose. In the event the final immunizing dose would be given after the seventh birthday, use tetanus-diphtheria toxoids (Td) adult formulation.

Booster Immunization:
For children between 4 and 6 years of age (preferably at time of kindergarten or elementary school entrance), a booster of 0.5 mL should be administered intramuscularly. Those who receive all four primary immunizing doses before their fourth birthday should receive a single dose of DT just before entering kindergarten or elementary school. This booster dose is not necessary if the fourth dose in the primary series was given after the fourth birthday. Thereafter, routine booster immunizations should be with tetanus-diphtheria toxoids (Td) adult formulation, at intervals of 10 years.

Catch-up schedule: Age at onset of immunization series: Children 4 months through 6 years (prior to 7th birthday): 3 doses at least 4 weeks apart followed 6 months later with dose 4; a 5th dose may be given 6 months later (the 5th dose is not necessary if the child received the 4th dose after 4 years of age).

Tetanus prophylaxis in wound management: Use of tetanus toxoid (DT or Td) and/or tetanus immune globulin (TIG) depends upon the number of prior tetanus toxoid (TT) doses and type of wound: A single 0.5 mL dose IM:
Clean, minor wounds:
Prior number of tetanus toxoid doses is unknown or less than 3: DT or Td or Tdap
Prior number of tetanus toxoid doses is 3 or more: Td only if more than 10 years since last dose
If only three doses of fluid tetanus toxoid have been received, a fourth dose of toxoid, preferably an adsorbed toxoid, should be given.
All other wounds:
Prior number of tetanus toxoid doses is unknown or less than 3: DT or Td or Tdap (tetanus/diphtheria/pertussis, accel) and TIG (tetanus immune globulin)
Prior number of tetanus toxoid doses is 3 or more: Td only if more than 5 years since last dose

Use of combined antigen immunization (DT, Td, or DTaP - diphtheria/tetanus/pertussis, accel) is preferred. Use tetanus and diphtheria toxoids formulation based upon age; use pediatric preparations (DT or DTaP) if the patient is less than 7 years old and Td if 7 years or older. Tdap is preferred in adolescents 10 years or older and adults who have never received Tdap. Td is preferred to TT in adolescents 10 years or older and adults who received Tdap previously or when Tdap is not available. If TT and TIG are both used, tetanus toxoid (adsorbed) rather than tetanus toxoid (fluid) should be used.

Usual Pediatric Dose for Tetanus Prophylaxis:

DT (pediatric) formulation:
Primary Immunization:
6 weeks to 1 year: Three doses of 0.5 mL IM at least 4 weeks apart followed by a fourth dose 6 to 12 months after the third dose. Preterm infants should be vaccinated according to their chronological age from birth.

1 to 6 years: Two 0.5 mL IM doses given at least 4 weeks apart followed by a fourth dose 6 to 12 months after the third dose. In the event the final immunizing dose would be given after the seventh birthday, use tetanus-diphtheria toxoids (Td) adult formulation.

Booster Immunization:
For children between 4 and 6 years of age (preferably at time of kindergarten or elementary school entrance), a booster of 0.5 mL should be administered intramuscularly. Those who receive all four primary immunizing doses before their fourth birthday should receive a single dose of DT just before entering kindergarten or elementary school. This booster dose is not necessary if the fourth dose in the primary series was given after the fourth birthday. Thereafter, routine booster immunizations should be with tetanus-diphtheria toxoids (Td) adult formulation, at intervals of 10 years.

Catch-up schedule: Age at onset of immunization series: Children 4 months through 6 years (prior to 7th birthday): 3 doses at least 4 weeks apart followed 6 months later with dose 4; a 5th dose may be given 6 months later (the 5th dose is not necessary if the child received the 4th dose after 4 years of age).

Tetanus prophylaxis in wound management: Use of tetanus toxoid (DT or Td) and/or tetanus immune globulin (TIG) depends upon the number of prior tetanus toxoid (TT) doses and type of wound: A single 0.5 mL dose IM:
Clean, minor wounds:
Prior number of tetanus toxoid doses is unknown or less than 3: DT or Td or Tdap
Prior number of tetanus toxoid doses is 3 or more: Td only if more than 10 years since last dose
If only three doses of fluid tetanus toxoid have been received, a fourth dose of toxoid, preferably an adsorbed toxoid, should be given.
All other wounds:
Prior number of tetanus toxoid doses is unknown or less than 3: DT or Td or Tdap (tetanus/diphtheria/pertussis, accel) and TIG (tetanus immune globulin)
Prior number of tetanus toxoid doses is 3 or more: Td only if more than 5 years since last dose

Use of combined antigen immunization (DT, Td, or DTaP - diphtheria/tetanus/pertussis, accel) is preferred. Use tetanus and diphtheria toxoids formulation based upon age; use pediatric preparations (DT or DTaP) if the patient is less than 7 years old and Td if 7 years or older. Tdap is preferred in adolescents 10 years or older and adults who have never received Tdap. Td is preferred to TT in adolescents 10 years or older and adults who received Tdap previously or when Tdap is not available. If TT and TIG are both used, tetanus toxoid (adsorbed) rather than tetanus toxoid (fluid) should be used.

What other drugs will affect diphtheria and tetanus toxoids vaccine?

Before receiving this vaccine, tell the doctor about all other vaccines your child has recently received.

Also tell the doctor if your child has received drugs or treatments in the past 2 weeks that can weaken the immune system, including:

  • steroids (oral, nasal, inhaled, or injectable);

  • medications to treat psoriasis, rheumatoid arthritis, or other autoimmune disorders, such as azathioprine (Imuran), etanercept (Enbrel), leflunomide (Arava), and others; or

  • medicines to treat or prevent organ transplant rejection, such as basiliximab (Simulect), cyclosporine (Sandimmune, Neoral, Gengraf), muromonab-CD3 (Orthoclone), mycophenolate mofetil (CellCept), sirolimus (Rapamune), or tacrolimus (Prograf).

If your child is using any of these medications, he or she may not be able to receive the vaccine, or may need to wait until the other treatments are finished.

This list is not complete and other drugs may interact with this vaccine. Tell your doctor about all medications your child receives. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your doctor or pharmacist can provide more information about this vaccine. Additional information is available from your local health department or the Centers for Disease Control and Prevention.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 3.01. Revision Date: 2011-06-29, 10:22:43 AM.

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