Tetanus-Diphtheria Toxoids, Adult Disease Interactions

Ideally, vaccination should occur when an individual is healthy, thus minimizing the risk of an adverse host reaction and/or vaccine failure. However, a current or recent infection does not necessarily preclude the use of vaccines, depending on the severity of the patient's symptoms and their etiology. Superficial infections and minor acute illnesses such as a mild upper respiratory infection with or without low-grade fever do not contraindicate immunization, particularly if prompt administration of a vaccine is deemed necessary or beneficial. In fact, when vaccines are administered during the course of a minor illness, the risk of adverse events is not increased, and serum antibody response is not often diminished. On the other hand, if fever or symptoms suggest a moderate or severe illness, it is usually appropriate to withhold vaccination until the patient has recovered. In addition to the potential risks already mentioned, evolving signs and symptoms of the illness can sometimes confound the diagnosis of a vaccine reaction if it develops. In the presence of any infection, the decision to administer or withhold/defer immunization should take into consideration the benefits versus the risks to an individual patient.

In patients with thrombocytopenia or coagulation disorders, intramuscular injections may produce bleeding and hematomas. Patients with a platelet count less than 50,000/mm3 are at an increased risk. Caution is advised if the vaccine (e.g., plague vaccine, hepatitis A and B vaccines, and aluminum-adsorbed DTaP, DTP, DT, or Td) must be administered intramuscularly. The risk of bleeding may be minimized by vaccination immediately after the administration of replacement factor, use of a 23-gauge (or smaller) needle, and immediate application of direct pressure to the vaccination site for at least 2 minutes.

The expected serum antibody responses may not be obtained when vaccines and/or toxoids are administered to patients with primary or acquired immunodeficiency, including those with severe combined immunodeficiency, hypogammaglobulinemia or agammaglobulinemia, HIV infection, altered immune states (due to diseases such as leukemia, lymphoma, or generalized malignancy), or immunosuppression due to drug or other treatments (e.g., corticosteroids, alkylating agents, antimetabolites, or radiation).