Diphtheria vaccination

The WHO Regional Committee for Europe has set a target of “reducing the incidence of diphtheria to 0.1 or less per 100,000 population by 2020 or earlier”. In 2006, 182 cases were detected (incidence 0.13). Despite this, the importance of efforts to vaccinate children against diphtheria is obvious. Since more than 10 years have passed since mass vaccination of adults, another mass revaccination is necessary.

Indications and method of administration of the diphtheria vaccine

Anatoxins (all preparations) are administered to children of early and preschool age only intramuscularly in a dose of 0.5 ml; for older children and adults they can be administered deep subcutaneously.

ADS is administered to children aged 3 months to 6 years who have contraindications to DPT or have had whooping cough. The vaccination course is 2 doses with an interval of 30-45 days, revaccination - once after 9-12 months. (children aged 6 years or older are revaccinated with ADS-M). If a child who has had whooping cough has already received 1 DPT vaccination, he is given 1 dose of ADS with revaccination after 9-12 months; if he has received 2 DPT vaccinations, only revaccination with ADS is carried out after 9-12 months.

ADS-M is used for revaccination of children at 7 years of age, adolescents at 14 years of age and adults every 10 years, as well as for vaccination of previously unvaccinated persons over 6 years of age (2 vaccinations with an interval of 30-45 days, the first revaccination after 6-9 months, the second after 5 years, then every 10 years). ADS-M is used in diphtheria foci.

AD-M is used for planned age-related revaccinations of individuals who received AS in connection with emergency tetanus prophylaxis.

Diphtheria Vaccination: Characteristics of the Drugs

Diphtheria toxoids registered in Russia

Anatoxin	Content	Dosage
ADS - diphtheria-tetanus toxoid, Microgen, Russia	1 ml contains 60 LF of diphtheria and 20 EU of tetanus AT.	Administered intramuscularly to children under 6 years of age at 0.5 ml (>30 IU diphtheria and >40 IU tetanus AT)
ADS-M - diphtheria-tetanus toxoid, Microgen, Russia	1 ml contains 10 LF of diphtheria and 10 EU of tetanus AT.	Administer 0.5 ml intramuscularly to children over 6 years of age and adults, primary series - 2 doses + booster
AD-M - diphtheria toxoid, Microgen, Russia	In 1 ml 10 LF of diphtheria toxoid	Administer 0.5 ml intramuscularly to children over 6 years of age and adults, primary series - 2 doses + booster

Diphtheria toxoids licensed in Russia are adsorbed on aluminum hydroxide, preservative - thimerosal (0.01%). Storage at 2-8°. Frozen preparations are not suitable. Shelf life is 3 years. In addition, toxoids are included in DPT, Tetrakok, Infanrix, Pentaxim, as well as Bubo-M, Bubo-Kok.

Immunity and vaccination of those who have recovered

The administration of drugs according to the given schemes leads to the formation of antitoxic antibodies that prevent the development of symptoms of diphtheria (or sharply alleviate them) and tetanus in 95-100% of those vaccinated.

Diphtheria of any form in unvaccinated children and adolescents is considered the first vaccination against diphtheria, in those who received one vaccination before the disease - as the second vaccination. Further vaccination against diphtheria is carried out according to the current calendar. Children and adolescents who have received complete vaccination, one or more revaccinations, as well as adults after mild diphtheria without complications are not subject to additional vaccination. Children and adolescents vaccinated two or more times and who have had severe forms of diphtheria should be vaccinated once in a dose of 0.5 ml, and adults - twice, but not earlier than 6 months after the disease. Subsequent revaccinations in all cases should be carried out according to the Calendar.

Post-exposure prophylaxis of diphtheria

Persons who have not been vaccinated against diphtheria, as well as children and adolescents whose next revaccination is due, and adults who were vaccinated, according to documentation, 10 or more years ago, are subject to immediate vaccination in case of close contact with a patient with diphtheria. Persons who have not been found to have protective titers of diphtheria antibodies (1:20 or more) during screening are also subject to vaccination.

WHO recommends chemoprophylaxis for people who have had close (family, sexual) contact with a patient with diphtheria before receiving negative culture results, which prevents the spread of the infection. Oral medications (Ospen, macrolides) are prescribed, which, if culture is positive, are administered for 10 days, or benzathine penicillin intramuscularly once at a dose of 600,000 IU for children under 6 years of age and 1,200,000 IU for older children.

Contraindications to the diphtheria vaccination

There are no absolute contraindications to the diphtheria vaccination. If allergic reactions develop, the next dose is administered against the background of corticosteroid drugs. Routine vaccinations of pregnant women are not recommended. The diphtheria vaccination is administered to chronically ill patients during the remission period, including against the background of maintenance therapy.

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Side effects and complications after vaccination against diphtheria

Anatoxins are weakly reactogenic, rare reactions are local hyperemia and induration, short-term subfebrile condition and malaise. Children with a history of febrile seizures should be given paracetamol before vaccination. Isolated cases of anaphylactic shock and neurological reactions have been described. Local allergic reaction occurs in people who have received AS many times.