DIPHTHERIA, TETANUS and
WHOOPING COUGH (pertussis), POLIO
Diphtheria caused more deaths in Australia than any other infection in the early 1900’s. It is a highly contagious bacterial infection typically affecting the throat and tonsils with the formation of a thick grey membrane over those areas. Death is either due to asphyxiation by the membrane or from the effects of a toxin produced by the bacteria which affects the heart and nervous system. Now uncommon here, countries where immunisation levels have fallen have seen the re-emergence of this deadly disease.
Tetanus is a bacteria which lives in soil and contaminates wounds, where it produces a powerful toxin, The toxin attacks the nervous system causing increasing muscle spasm and rigidity. The muscles of the jaw are usually first affected, hence the name ‘lock jaw’. Even with modern treatment, 10 % of those infected will die.
Whooping Cough (pertussis) is one of the most contagious bacterial infections known. Beginning with a runny nose and sore throat, it progresses to a severe spasmodic cough which persists for around 3 months. Coughing episodes are often followed by a typical ‘whoop’ sound and vomiting. Life threatening complications are pneumonia, inflammation of the brain (encephalitis) and brain haemorrhage from the severe coughing. Children under 6 months of age are at the greatest risk of fatal complications.
In 1999 an ‘acellular’ form of the pertussis component of the vaccine was introduced into the Australian immunisation schedule – this has resulted in a much lower rate of side effects compared with the older forms of the vaccine.
Polio is dealt with in the Polio sheet, but inactivated polio vaccine has more recently been incorporated in the Triple Antigen vaccine.
Triple Antigen IPV immunises against each of these four diseases – it is not a live vaccine.
The primary course of triple antigen IPV involves immunisation at 2, 4 and 6 months and a booster at 4 years of age.
Adverse reactions have been dramatically reduced with the introduction of the new ‘acellular’ vaccine. The most common are low-grade fever, local redness and swelling at the injection site, drowsiness or tiredness, irritability and crying.
A painless lump, which may be present for a number of weeks, may be felt at the site of injection – this is not significant.
Occasionally fever may be worse and can be associated with a febrile convulsion.
Episodes of temporary neurological symptoms ( pallor, limpness and unresponsiveness) – with no long term complications – have been reported in between 1 in 1 to 10 million vaccinations. ( more than 1 in 100 cases of whooping cough are associated with neurological complications).
Triple antigen does not increase the risk of SIDS (it is reduced by immunisation) or epilepsy.
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The following children SHOULD NOT be immunised with triple antigen IPV (although tetanus and diphtheria alone may usually be given) :
Encephalopathy (but not febrile convulsion) within 7 days of a previous immunisation – in the absence of another cause.
Immediate severe allergic reaction to a previous triple antigen.
Precautions should be taken with a history of
:
A convulsion after a previous immunisation or a fever over 40.5 degrees.
Persistent inconsolable screaming or unusual high pitched cry lasting more than
3 hours.
Hypotonic – hyporesponsive episode (very flat and limp) within 48 hours of
vaccination.
Severe limb swelling and redness after vaccination.
Children with active or progressive neurological disease can be vaccinated, but immunisation should be deferred if there has been a convulsion in the previous 3 weeks.
Immunisation should be deferred in the presence of a fever
over 38.5 degrees,