Tetanus, Diphtheria, acellular Pertussis (Tdap)
Disease Description: Tetanus, an acute disease caused by Clostridium tetani, is characterized by muscle rigidity and painful spasms, often starting in the muscles of the jaw and neck. Severe tetanus can lead to respiratory failure and death. The disease is caused by a neurotoxin produced by anaerobic tetanus bacilli growing in contaminated wounds.
Diphtheria is an acute bacterial disease caused by toxigenic strains of Corynebacterium diphtheriae. Early symptoms of respiratory diphtheria include malaise, sore throat, difficulty in swallowing, loss of appetite, and a mild fever (rarely >101o F). Extensive pharyngeal membrane formation may result in life-threatening or fatal airway obstruction. Diphtheria toxin can cause serious systemic complications, including inflammation of the heart and neuropathies, if it is absorbed from the site of infection. The case-fatality rate of respiratory diphtheria is 5%-10%.Pertussis, caused by the bacterium Bordetella pertussis, is a highly communicable respiratory illness characterized by pro-longed paroxysmal coughing, whoop, and/or posttussive vomiting. Persons in all age groups can be infected. Complications and deaths from pertussis are most common among unvaccinated infants. Older children and adults may more frequently manifest less severe symptoms, such as persistent cough without whoop.
Risk to Travelers: Tetanus can occur anywhere in the world in inadequately vaccinated persons. Travelers to countries with endemic diphtheria are at a higher risk of disease following exposure to toxigenic C. diphtheriae if they are inadequately immunized or not up-to-date with diphtheria booster immunizations. Pertussis remains endemic worldwide, even in countries with high vaccination rates. Unvaccinated infants traveling to countries with low pertussis-containing vaccine coverage may be at higher risk of severe disease.
Prevention - Vaccine: Persons who have received primary immunization for tetanus, diphtheria, and pertussis should receive booster doses of tetanus toxoid and diphtheria containing vaccines at minimum of ten year intervals. Adults who have not yet received a dose of Tetanus, Diphtheria, acellular Pertussis (Tdap) should receive this one time instead of Td when they are due for their next booster. This is particularly important for persons caring for infants and young children.
Vaccine Adverse Effects: Local reactions (redness and induration with or without tenderness) are common after the administration of vaccines containing diphtheria, tetanus, or pertussis antigens. Anaphylactic and other serious adverse events are rare after receipt of preparations containing diphtheria, tetanus or pertussis components, or a combination of these.
Vaccine Contraindications: An immediate anaphylactic reaction to a prior dose of vaccine or vaccine component is a contraindication to further vaccination with Td or Tdap. Encephalopathy (mental confusion) not due to another identifiable cause within 7 days of vaccination is a contraindication to further vaccination with a pertussis-containing vaccine.
Vaccine Booster Recommendations: At this time it is only recommended that Tdap be given one time. Subsequent boosters would be with Td.
Information adapted from CDC Health Information for International Travel (the Yellow Book), http://www.cdc.gov/travel/yellowbook/2010/table-of-contents.htm