Diphtheria – in this disease the bacteria is colonized in the throat, the nose and mainly in the tonsils. An open wound is created, and dead cells accumulate on it and turn into a crust. The inflammation and the swelling that evolve around the crust can cause suffocation. The bacteria secrete a toxin that hurts the heart and the brain. The process is accompanied by throat ache and high fever. The bacteria is transferred from one person to the other when coughing and sneezing or by exposure to phlegm or nose secretions. The risk for a non-immune person to be sick after exposure to the bacteria is very high, and the mortality rate from the disease is high as well.
Tetanus – the disease characterized by muscle spasm that could result in paralysis of a variety of muscles, including the respiratory muscles. The mortality rate of this disease is very high. the bacteria can penetrate the body through a wound in the skin, and in the case of a non-immune person could lead to a severe disease. Deep injuries that are infected with soil, feces or saliva are extremely dangerous. Among babies, the Tetanus disease is caused by inappropriate treatment of the umbilical cord, and that is the most common cause of neonatal death in developing countries. The bacteria is not contagious (cannot be transmitted from person to person).
Pertussis – pertussis is a contagious infectious disease that is caused by bacteria called Bordetella Pertussis. The bacteria excrete toxins that harm the respiratory tract and cause many of the symptoms that characterize the disease. The first stage of the disease is characterized by flu-like symptoms, including a slight cold, cough, a runny nose, and a fever. Other symptoms might include a dry cough, lack of appetite and a general weakness. Worsening of the symptoms will appear after 1-2 weeks, and will include worsening of the cough to severe coughing attacks, which can last longer than a minute. These attacks of persistent cough end with a characteristic sound while inhaling air, referred to as Whooping. During prolonged coughing fits, the child might have difficulty breathing and have a red or blue discoloration of the face. In addition to that, during a severe coughing spell, there might also be short moments with lack of breathing, and repetitive vomiting at the end of the fit. These coughing spells can cause shortness of breath, lack of appetite, general weakness and sleep disturbances.
The triple vaccine – the symptoms of the Tetanus and Diphtheria diseases are caused due to a toxin that the bacteria releases within our body. The vaccines aimed against these two diseases imitate the structure of the toxin, by thus allowing our immune system to get acquainted with the toxin and create antibodies against the real toxins. The vaccine’s components are similar to the toxins structure but are not dangerous.
There are two types of vaccines for Pertussis. The first one is a-cellular, named DTaP, meaning it includes some of the particles from the envelope and the toxins of the bacteria. The major advantage of this vaccine is that it has a reduced rate of local and systemic side effects, such as fever, irritability, and lack of appetite. The second vaccine contains dead bacteria. As a result of increasing use of the vaccine in the population, there has been a significant decrease in morbidity and mortality from this disease.
The adverse effects of the Pertussis vaccine are usually mild, not dangerous and affect only 10% of the recipients. There could be some local adverse effects such as redness, swelling and pain in the area in which the vaccine was administered within 24 hours. In addition to that, there could be some systemic adverse effects which include nausea, vomiting, lack of appetite, irritability, diarrhea, fatigue, and fever. Seldom a seizure might appear 2-3 days after the vaccination. Usually accompanied by a fever. These seizures are not considered dangerous and do not cause any permanent neurological damage.
There is no proven connection between the Pertussis vaccine and any neurological symptoms, but still, there are some cases in which you should avoid vaccinating your child.
What are the cases in which precautions should be taken?
In addition to the general warnings given regarding vaccination, you should avoid administering the Pertussis ingredient in the vaccine in the following cases:
1. Sensitivity to one of the vaccines’ components
2. A child that has developed neurological symptoms within a week of the prior vaccine, such as seizures (non-febrile) or changes in consciousness
3. In the presence of a progressive neurological disease characterized by a developmental delay or other progressive symptoms. In the case of a static neurological issue such as Cerebral Palsy, there is no prevention from vaccination.
4. Children with a personal or family history of seizures have an elevated risk of seizure after vaccination. If a seizure appears, usually, it is a febrile convulsion, and it does not leave any permanent damage and doesn’t cause epilepsy. However, with children who had a recent seizure, it is preferable to postpone the Pertussis vaccination until the nature of the seizure will become apparent and the presence of a progressive neurological disease will be ruled out. As mentioned before, when a child has a balanced and controlled epilepsy, the vaccine can be administered. In these cases, it is preferable to use medications to lower the fever during the vaccination the following day.
5. A family history of seizures, adverse effect from the vaccine or Sudden Infant Death Syndrome (SIDS) after Pertussis vaccination are not contraindications for administering the Pertussis vaccine.
There are no specific contraindications for the administration of the Diphtheria – Tetanus vaccine, besides the general warnings mentioned before.
In Nepal, the DTP vaccine is given at three doses, at the ages of 6, 10 and 14 weeks, as part of the National childhood immunization program. According to the latest data from the WHO the estimated coverage of the vaccine in Nepal is approximately 90%.